GnRH agonist triggering is one of the strategies for ovulation triggering and final maturation of oocytes. So , should be notice for luteal phase support in these cycles. At the first it was began for prevention of severe OHSS but it was associated with luteal phase problem and lower pregnancy rate due to luteolysis effects of GnRH agonists. So, two other alternative strategies have been suggested , the first was dual triggering with GnRH-a and low dose hCG and the second was 1500 units of hCG on the day of oocyte pick up to replace the actions of early luteal LH to sustain implantation and endogenous luteal ovarian steroidogenesis. Sometimes the physician avoids hCG injection and instead focuses on correcting the abnormal luteal steroid profile by providing intensive luteal-phase support with oestradiol and progesterone, Although the pregnancy rate is lower in the fresh embryo transfer but in donor recipient and frozen embryo cycles there was no significant differences between GnRH-a triggering and hCG. It shows that the oocyte quality is not disturbed by GnRH agonist triggering. It may be associated to endometrial gen expression. The endometrial gene expression after the GnRH agonist trigger and a modified luteal phase support( with 1500 IU of hCG on the day of OPU was similar to the pattern seen after the hCG trigger and standard luteal phase support but it does not eliminate the risk of OHSS. However, Regarding the optimal results of segmental IVF, it is recommended to use from GnRH agonist for ovulation triggering and postpone the embryo transfer to the another cycle.
Materials and methods