{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:27:04Z","timestamp":1774272424372,"version":"3.50.1"},"reference-count":92,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["raf.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>\n                      <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"\/journals\/raf\/6\/4\/images\/RAF-24-0105inf1.jpeg\"\/>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Using a large patient series, we aimed to evaluate, in a high-responder population, the effect of triggering oocyte maturation with human choriogonadotropin (hCG) or with a gonadotropin-releasing hormone agonist (GnRHa). We analyzed data from 683 intended fresh embryo transfer cycles (ETCs) and 534 frozen-thawed embryo transfer (FET) cycles. The rates of ovarian hyperstimulation syndrome (OHSS), and the embryological, clinical, and newborn outcomes were compared. Considering the type of oocyte maturation trigger and embryo destination, cycles were divided into five groups. Cycles using an hCG-trigger, with progesterone luteal support, had fresh embryo transfer or embryo freeze-all (FA). Cycles using GnRHa\/agonist-trigger, with hCG, estrogen, and progesterone luteal support, had fresh embryo transfer or embryo FA. The fifth group consisted of agonist-trigger cycles, without luteal support, that underwent embryo FA. Severe OHSS only occurred in fresh ETC, with the agonist-trigger evidencing a non-significantly lower rate. The FA groups evidenced higher numbers of retrieved oocytes and blastocyst rates. In fresh ETC, the Ag-fresh-hCG group evidenced higher implantation and clinical pregnancy rates. No differences were observed in clinical outcomes after FET, but cumulative clinical outcomes showed higher clinical pregnancy and newborn rates in the Ag-fresh-hCG group. After multivariable logistic regression analysis, these differences were not observed. The present results thus suggest that, in high-responders, the use of a GnRHa-trigger with luteal hCG in a fresh ETC presents similar outcomes relative to the use of an hCG-trigger. Data also suggest that FA should be applied to all suspected OHSS cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                    <jats:p>Ovarian hyperstimulation syndrome (OHSS) is a complication of medically assisted reproduction treatments that may require hospitalization. In the presence of high risk to develop OHSS, embryo transfer can be canceled and embryos frozen to be used in a later cycle. Alternatively, a newer drug, an agonist, can be used for egg trigger in association with endometrium special preparation. Some characteristics make women more susceptible to develop OHSS. In this group of patients, we observed that the use of an agonist as egg trigger did not decrease pregnancy outcomes and that the option of freezing all embryos followed by embryo transfer in a later cycle abolished development of OHSS with hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/raf-24-0105","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T12:09:42Z","timestamp":1759838982000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-13","source":"Crossref","is-referenced-by-count":0,"title":["Oocyte maturation triggers in high-responders: a report on 1,217 consecutive cycles"],"prefix":"10.1530","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7280-9015","authenticated-orcid":true,"given":"Maria","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Laboratory of Cell Biology, Department of Microscopy, ICBAS-Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar, Universidade do Porto, Porto, Portugal"},{"name":"UMIB-Unit for Multidisciplinary Investigation in Biomedicine\/ITR-Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9136-6400","authenticated-orcid":true,"given":"Mariana","family":"Cunha","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Teixeira da Silva","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3799-3232","authenticated-orcid":true,"given":"Joaquina","family":"Silva","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0703-7119","authenticated-orcid":true,"given":"Paulo","family":"Viana","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"}]},{"given":"Cristiano","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0042-5853","authenticated-orcid":true,"given":"Margarida Fonseca","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Department of Population Studies, ICBAS-Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar, University of Porto, Porto, Portugal"},{"name":"CIIMAR-Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal"}]},{"given":"Alberto","family":"Barros","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Genetics, Porto, Portugal"},{"name":"Unit of Genetics, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"RISE-Health Research Network, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-3290","authenticated-orcid":true,"given":"M\u00e1rio","family":"Sousa","sequence":"additional","affiliation":[{"name":"Laboratory of Cell Biology, Department of Microscopy, ICBAS-Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar, Universidade do Porto, Porto, Portugal"},{"name":"UMIB-Unit for Multidisciplinary Investigation in Biomedicine\/ITR-Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Front Endocrinol","article-title":"Reproductive outcome after GnRH agonist triggering with co-administration of 1500 IU hCG on the day of oocyte retrieval in high responders: a long-term retrospective cohort study","volume":"13","author":"Abdulkhalikova D","year":"2022","unstructured":"Abdulkhalikova D\n, \nBokal EV\n, \nStimpfel M\n, et al.\n 2022 Reproductive outcome after GnRH agonist triggering with co-administration of 1500 IU hCG on the day of oocyte retrieval in high responders: a long-term retrospective cohort study. 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(https:\/\/doi.org\/10.3109\/09513590.2015.1025379)"},{"key":"bib12","series-title":"Syst Biol Reprod Med","first-page":"336","article-title":"The continuum of high ovarian response: a rational approach to the management of high responder patient subgroups","volume":"61","author":"Gat I","year":"2015","unstructured":"Gat I\n, \nShlush E\n, \nQuach K\n, et al.\n 2015 The continuum of high ovarian response: a rational approach to the management of high responder patient subgroups. Syst Biol Reprod Med 61 336\u2013344. (https:\/\/doi.org\/10.3109\/19396368.2015.1089607)"},{"key":"bib13","series-title":"Genes","first-page":"2095","article-title":"Preimplantation genetic testing for genetic diseases: limits and review of current literature","volume":"14","author":"Giuliano R","year":"2023","unstructured":"Giuliano R\n, \nMaione A\n, \nVallefuoco A\n, et al.\n 2023 Preimplantation genetic testing for genetic diseases: limits and review of current literature. Genes 14 2095. (https:\/\/doi.org\/10.3390\/genes14112095)"},{"key":"bib14","series-title":"Asian J Androl","first-page":"338","article-title":"Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia","volume":"19","author":"Gon\u00e7alves C","year":"2017","unstructured":"Gon\u00e7alves C\n, \nCunha M\n, \nRocha E\n, et al.\n 2017 Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia. Asian J Androl 19 338\u2013345. (https:\/\/doi.org\/10.4103\/1008-682X.172827)"},{"key":"bib15","series-title":"J Clin Endocrinol Metab","first-page":"918","article-title":"Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization","volume":"71","author":"Gonen Y","year":"1990","unstructured":"Gonen Y\n, \nBalakier H\n, \nPowell W\n, et al.\n 1990 Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab 71 918\u2013922. (https:\/\/doi.org\/10.1210\/jcem-71-4-918)"},{"key":"bib16","series-title":"Fertil Steril","first-page":"1392","article-title":"The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome","volume":"94","author":"Grossman LC","year":"2010","unstructured":"Grossman LC\n, \nMichalakis KG\n, \nBrowne H\n, et al.\n 2010 The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome. Fertil Steril 94 1392\u20131398. (https:\/\/doi.org\/10.1016\/j.fertnstert.2009.07.1662)"},{"key":"bib17","series-title":"F S Rep","first-page":"15","article-title":"GnRHa trigger-the story of the ugly duckling","volume":"4","author":"Humaidan P","year":"2023","unstructured":"Humaidan P\n & \nHaahr T\n\n 2023 GnRHa trigger-the story of the ugly duckling. F S Rep 4 (2 Supplement) 15\u201319. (https:\/\/doi.org\/10.1016\/j.xfre.2023.02.011)"},{"key":"bib18","series-title":"Hum Reprod","first-page":"1213","article-title":"GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF\/ICSI cycles: a prospective randomized study","volume":"20","author":"Humaidan P","year":"2005","unstructured":"Humaidan P\n, \nBredkjaer HE\n, \nBungum L\n, et al.\n 2005 GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF\/ICSI cycles: a prospective randomized study. Hum Reprod 20 1213\u20131220. 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Reprod Biomed Online 24 134\u2013141. (https:\/\/doi.org\/10.1016\/j.rbmo.2011.11.001)"},{"key":"bib22","series-title":"Hum Reprod","first-page":"2511","article-title":"GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients","volume":"28","author":"Humaidan P","year":"2013a","unstructured":"Humaidan P\n, \nPolyzos NP\n, \nAlsbjerg B\n, et al.\n 2013a GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients. Hum Reprod 28 2511\u20132521. 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