During controlled ovarian stimulation for IVF, a GnRH agonist (leuprolide) is used instead of hCG for final oocyte maturation trigger in a high-responder PCOS patient. What is the primary advantage of this strategy?

• A Improved oocyte maturity and fertilization rates
• B Better endometrial receptivity for fresh embryo transfer
• C Significantly reduced risk of ovarian hyperstimulation syndrome (OHSS) ✓
• D Reduced total gonadotropin dose required for stimulation

Explanation

GnRH agonist trigger induces an endogenous LH surge that has a short half-life compared to hCG, causing rapid luteolysis and dramatically reducing OHSS risk in high responders. The trade-off is luteal phase deficiency requiring intensive progesterone support or freeze-all strategy. Option A is incorrect as oocyte maturity is comparable. Option B is wrong as fresh transfer is often avoided. Option D is unrelated to the trigger choice.

Reference: Practice Committee of ASRM Guidelines, 2022 ed.

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