In IVF, controlled ovarian hyperstimulation (COH) with gonadotrophins triggers with a GnRH agonist (leuprolide acetate trigger) is preferred over hCG trigger in which clinical situation?

• A Women at high risk of ovarian hyperstimulation syndrome (OHSS) in GnRH antagonist cycles ✓
• B Women with poor ovarian response (low AFC)
• C Women undergoing long GnRH agonist protocol (down-regulation)
• D Women with unexplained infertility undergoing intrauterine insemination

Explanation

GnRH agonist trigger (leuprolide) is used in GnRH antagonist cycles — it induces a surge of both LH and FSH by acting on pituitary GnRH receptors (which remain functional since a GnRH antagonist not agonist was used for suppression). The resulting LH surge has a shorter half-life than exogenous hCG, dramatically reducing the risk of OHSS. It cannot be used in the long GnRH agonist (down-regulation) protocol because the pituitary is desensitised and cannot respond. Freeze-all strategy is typically combined to avoid fresh transfer risk of OHSS.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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