O-293 The GnRH-agonist trigger alone can be used for egg maturation in altruistic egg donors using long-acting reversible contraceptives without compromising the outcome
Authors: Mascarenhas M , Nobrega N , Fleming R , Gaudoin M 
Published: June 2022

Abstract

Study question
Does use of long-acting reversible contraceptives (LARC) compromise the efficacy of a GnRH agonist trigger in egg donors?

Summary answer
Using a GnRH-agonist trigger in altruistic egg donors using LARCs does not appear to compromise oocyte yield or maturity.

What is known already
GnRH-agonist triggers are recommended for altruistic egg donors to reduce the risk of ovarian hyperstimulation syndrome (OHSS) as any impact on the luteal phase would be clinically irrelevant. There is increasing usage of LARCs by young women due to their convenience and side-effect profile. A recent British Fertility Society survey (Mascarenhas et. al., 2021) indicated that many clinicians recommend removal before starting ovarian stimulation which incurs inconvenience to the donors and also risks unintended pregnancy. We had previously confirmed that women with LARC would respond to a GnRH-agonist trigger with an LH release deemed sufficient to induce oocyte maturation.

Study design, size, duration
Electronic records of 56 altruistic egg donation cycles with a GnRH-agonist trigger between January 2017 and December 2021 were retrospectively analysed. Of these, 38 were not on contraception or using non-hormonal contraceptive methods (Nil group), five were using oral contraception (Pill group), nine had a copper or levonorgesterol intrauterine device in situ (IUCD group) and four had a LARC in situ (LARC group).

Participants/materials, setting, methods
All stimulation involved GnRH-antagonist control. Donors with IUCDs or LARCs in situ were advised they could continue on their choice of contraception throughout the egg donation process. Oocyte retrieval was performed 36-37 hours post-GnRH-agonist trigger. The number of oocytes retrieved and the number of mature oocytes were recorded. As the numbers were small, the data is presented as median and interquartile range (IQR) and, given the small numbers, statistical analyses were expectedly, not significantly different.

Main results and the role of chance
The median age and AMH of the Nil group was 27.2 (IQR 25.4-29.3) years and 41.0 (IQR 33.0-65.3) pmol/L, for the IUCD group was 28.8 (IQR 24.8-29.3) years and 45.0 (IQR 38.0-54.0) pmol/L, and for the Pill group was 26.0 (IQR 24.0-27.2) years and 36.0 (31.0-40.0) pmol/L. Women in the LARC group were younger than in the nil group with a median age of 23.3 (IQR 22.6-23.6) (p = 0.016), but with no significant difference in the AMH levels 32.6 (IQR 22.8-40.5) pmol/L.
There was no difference apparent in the number of oocytes retrieved between the groups: Nil group = 18.5 (IQR 12-24); Pill group = 21 (IQR 21-23); IUCD group = 19 (IQR 18-20); LARC group = 23 (IQR 11-33).
The number of mature oocytes also appeared similar: Nil group = 14 (IQR 9-22); Pill group = 19 (IQR 17-20); IUCD group = 17 (IQR 15-18); LARC group = 19 (IQR 11-26).
The oocyte maturity rates were also similar: Nil group = 86%; Pill group = 83%; IUCD group = 89%; LARC group = 78%.

Limitations, reasons for caution
A retrospective cohort study carries inherent disadvantages of confounding variables or variation in baseline characteristics as compared with a randomised controlled trial. The low sample size would have meant that results of any statistical analysis runs the risk of being insignificant or spurious which we have therefore deliberately refrained from.

Wider implications of the findings
Although derived from a small sample size, the finding that the GnRH-trigger alone can be deployed in women using LARCs without compromising egg numbers or maturity can give clinicians confidence to perform GnRH-agonist triggering for altruistic egg donors or others wishing to store eggs or embryos, thus maximising patient safety.

Trial registration number
Not applicable