Comparison of Gonadotropin-Releasing Hormone Agonist and Human Chorionic Gonadotrophin Ovulation Triggers in Women with Polycystic Ovarian Syndrome: A Randomized Controlled Trail
TL;DR
Gonadotrophin releasing hormone agonist is as effective as human chorionic gonadotrophin in triggering ovulation and achieving pregnancy in PCOS patients, with the added clinical advantage of eliminating the risk of ovarian hyperstimulation syndrome.
Abstract
Background: Ovulation induction in polycystic ovarian syndrome (PCOS) is challenging due to unpredictable ovarian response and risk of ovarian hyperstimulation syndrome (OHSS). This study aims to compare the efficacy and safety of gonadotropin-releasing hormone agonists (GnRH agonists) versus human chorionic gonadotropin (hCG) as an ovulation trigger in patients with polycystic ovarian syndrome. Methods: This Randomized Controlled Trial (RCT) was conducted at the Department of Reproductive Endocrinology and Infertility, Combined Military Hospital (CMH), Dhaka, from February 2023 to January 2024. Ninety-two (92) infertile women with PCOS undergoing ovulation induction with gonadotropins were randomly assigned to either the Experimental Group (gonadotropin-releasing hormone agonist trigger, n=46) or the Control Group (human chorionic gonadotrophin trigger, n=46). Triggers were administered when 1–3 dominant follicles reached ≥ 18 mm on folliculometry by transvaginal ultrasonogram. Primary outcomes included ovulation rates confirmed by ultrasound documented collapsed follicles and presence of fluid in the Pouch of Douglas, and mid-luteal serum progesterone level. Secondary outcomes were clinical pregnancy rates and the incidence of OHSS. Results: Baseline characteristics (age and BMI) were comparable between two groups. The cumulative ovulation rate over three cycles was slightly higher in human chorionic gonadotropin group (79.7%) compared to the gonadotropin-releasing hormone agonist group (75.5%), though this was not statistically significant (p=0.4). The cumulative pregnancy rate was 24.5% in human chorionic gonadotropin group and 21.3% in the gonadotropin-releasing hormone agonist group. In GnRH agonist group no patient developed OHSS, compared to 2.2% in the human chorionic gonadotropin group. Conclusion: Gonadotrophin releasing hormone agonist is as effective as human chorionic gonadotrophin in triggering ovulation and achieving pregnancy in PCOS patients, with the added clinical advantage of eliminating the risk of ovarian hyperstimulation syndrome. Bangladesh Armed Forces Med J Vol 59 No (1) June 2026, pp 62-68