Oocyte competence is independent of the ovulation trigger adopted: a large observational study in a setting that entails vitrified-warmed single euploid blastocyst transfer



To assess whether the GnRH-agonist or urinary-hCG ovulation triggers affect oocyte competence in a setting entailing vitrified-warmed euploid blastocyst transfer.


Observational study (April 2013–July 2018) including 2104 patients (1015 and 1089 in the GnRH-a and u-hCG group, respectively) collecting ≥1 cumulus-oocyte-complex (COC) and undergoing ICSI with ejaculated sperm, blastocyst culture, trophectoderm biopsy, comprehensive-chromosome-testing, and vitrified-warmed transfers at a private clinic. The primary outcome measure was the euploid-blastocyst-rate per inseminated oocytes. The secondary outcome measure was the maturation-rate per COCs. Also, the live-birth-rate (LBR) per transfer and the cumulative-live-birth-delivery-rate (CLBdR) among completed cycles were investigated. All data were adjusted for confounders.


The generalized-linear-model adjusted for maternal age highlighted no difference in the mean euploid-blastocyst-rate per inseminated oocytes in either group. The LBR per transfer was similar: 44% (n=403/915) and 46% (n=280/608) in GnRH-a and hCG, respectively. On the other hand, a difference was reported regarding the CLBdR per oocyte retrieval among completed cycles, with 42% (n=374/898) and 25% (n=258/1034) in the GnRh-a and u-hCG groups, respectively. Nevertheless, this variance was due to a lower maternal age and higher number of inseminated oocytes in the GnRH-a group, and not imputable to the ovulation trigger itself (multivariate-OR=1.3, 95%CI: 0.9–1.6, adjusted p-value=0.1).


GnRH-a trigger is a valid alternative to u-hCG in freeze-all cycles, not only for patients at high risk for OHSS. Such strategy might increase the safety and flexibility of controlled-ovarian-stimulation with no impact on oocyte competence and IVF efficacy.

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Author information




DC, AV, LR, and FMU conceived the study. DC and AV analyzed the data and drafted the manuscript. All authors contributed to data collection and discussion of the results.

Corresponding author

Correspondence to Danilo Cimadomo.

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Danilo Cimadomo and Alberto Vaiarelli are co-first authors.

Supplementary information

Supplementary Figure 1

Flowchart of the study. COS, controlled ovarian stimulation; COC, cumulus oocyte complex; MII, metaphase II. (PNG 221 kb)

Supplementary Figure 2

Distribution of the PGT-A cycles in the two groups under investigation (i.e. GnRH-agonist and urinary-hCG trigger) according to maternal age (A) and number of follicles with a mean diameter >15 mm on the day of trigger (B). Figure (C) shows the percentage of administration of GnRH-agonist and urinary-hCG trigger according to the ranges of number of follicles with a mean diameter >15 mm on the day of trigger, across the observational period (April 2013 to July 2018). The prevalence of severe and moderate-OHSS (ovarian hyperstimulation syndrome) is also reported. Statistically significant differences were assessed with Mann-Whitney U tests. (PNG 428 kb)

Supplementary Figure 3

Distribution of the PGT-A cycles in the two groups under investigation (i.e. GnRH-agonist and urinary-hCG trigger), according to the number of cumulus oocyte complexes (COCs) retrieved after oocyte pick-up. Statistically significant difference was assessed with Mann-Whitney U test. (PNG 182 kb)

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Cimadomo, D., Vaiarelli, A., Petriglia, C. et al. Oocyte competence is independent of the ovulation trigger adopted: a large observational study in a setting that entails vitrified-warmed single euploid blastocyst transfer. J Assist Reprod Genet (2021). https://doi.org/10.1007/s10815-021-02124-1

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  • GnRH-agonist
  • Urinary-hCG
  • Freeze-all
  • Aneuploidy testing
  • Oocyte competence