Does GnRH Agonist Triggering Control Painful Symptom Scores During Assisted Reproductive Technology? A Retrospective Study

Objective: The aim of this study was to assess the progression of pain symptoms during assisted reproductive technology (ART) cycles following administration of GnRH agonist (GnRHa) versus human chorionic gonadotrophin (hCG) triggering. Design: Observational cohort study. Setting: A tertiary care university hospital in France. Population: Patients who underwent ART programs. Methods: Between January 01, 2014, and June 31, 2014, 122 cycles were allocated to 2 groups: GnRHa triggering with a scheduled differed embryo transfer (n = 57) or hCG triggering with a fresh embryo transfer (n = 70). Pelvic pain scores were evaluated using a visual analog scale (VAS) with regard to dysmenorrhea, dyspareunia, noncyclic pelvic pain, gastrointestinal, and lower urinary tract pain. The total VAS score was defined as the sum of the scores for the various symptoms. Evaluations were carried out twice: during the synchronization treatment prior to ovarian stimulation and during a final evaluation 3 weeks postretrieval. The data were processed using univariate and multivariate logistic regression models. Main Outcome Measures: Trends for total VAS change (ie, final VAS score - synchronization VAS score). Results: For both groups, pain increased during the ART procedure. Trends for the total VAS change revealed that the increase in pain was significantly less in the GnRHa triggering group compared to the hCG triggering group (3.77 7.73 and 6.50 +/- 6.57, P < .05, respectively). Multivariate logistic regression indicated that GnRHa triggering was associated with less of an increase in pain compared to hCG triggering (odds ratio = 0.31, 95% confidence interval 0.13-0.71, P < .05). Conclusion: Compared to hCG, GnRHa triggering limits pain symptom progression in the period immediately after ART.