Administration of an Extra Gonadotropin Dose on Trigger Day in Patients Undergoing Elective Egg Freezing

Introduction:
The most common COHS protocol used in elective oocyte cryopreservation cycles is a GnRH antagonist protocol. There is no consensus about the timing of the final gonadotropin dose administration.

Aim:
To examine if an extra GT dose on trigger day during a GnRH antagonist cycle for oocyte cryopreservation results in improved cycle outcomes.

Methods and Materials:
A retrospective cohort of elective oocyte cryopreservation cycles at Hadassah Medical Center from 2017 through 2021.

Women who received their last GT dose a day before the trigger, and women with an extra dose on the trigger day. The primary outcome was the average number of mature oocytes.

Results:
We had 151 cycles with an extra GT dose and 297 cycles without it. Extra GT group had significantly higher day 3 FSH, lower AMH, and lower maximal Estradiol levels. They also had a significantly lower mean number of mature oocytes (11.1±7.1 vs. 6.4±4.5, p<0.001).

Additional analysis, dividing the two groups into subgroups of cycles with maximal E2 above and below 10,000 pmol\l was done. Interestingly, even with maximal E2 above 10,000 pmol\l, the extra dose group had poorer results (10.3±4.3 vs. 12.7±7.2, p< 0.001). This was also in cycles with E2 below 10,000 pmol\l (5.4±4.0 vs 8.7±6.1 mature oocytes, p= 0.011). A multiple regression model showed that the extra GT dose parameter was not associated with increased oocytes number.

Conclusions:
An extra GT dose on trigger day in patients undergoing elective egg freezing is not associated with increased oocyte yield.