Which agent is used to trigger final oocyte maturation in IVF, and what is a related risk?

• A. hCG trigger; risk includes ovarian hyperstimulation syndrome (OHSS) with hCG.
• B. GnRH antagonist trigger; risk includes LH surge.
• C. FSH trigger; risk includes OHSS.
• D. GnRH agonist trigger; risk includes potential luteal phase deficiency if luteal support is inadequate.

Answer: (D)

The main concept is how final oocyte maturation is triggered in IVF and what the main risk is with that trigger. In cycles using a GnRH antagonist to prevent premature ovulation, giving a GnRH agonist can induce an endogenous LH surge that drives the final maturation and ovulation of the oocyte. This approach lowers the risk of ovarian hyperstimulation syndrome (OHSS) compared with using hCG as the trigger, because the LH/ follicle stimulation is more transient and avoids the prolonged luteotrophic stimulus of hCG.

The trade-off is in the luteal phase. That brief LH surge from a GnRH agonist often isn’t enough to sustain robust corpus luteum function, so progesterone production can be inadequate unless luteal support is aggressively provided. Without adequate luteal support, there’s a higher chance of luteal-phase deficiency, which can compromise implantation or early pregnancy. That balance is why the best answer points to the GnRH agonist trigger and the risk of luteal-phase deficiency if luteal support isn’t adequate.