Impact of final oocyte maturation using gonadotropin releasing hormone agonist triggering and different luteal support protocols on endometrial gene expression

Genes related to endometrial receptivity were analyzed on 25 endometrial samples after GnRH-a triggering and different luteal support protocols; adding LH/hCG activity more closely resembles the expression after hCG triggering.


Alfonso Bermejo, M.D., María Cerrillo, M.D., María Ruiz-Alonso, David Blesa, Ph.D., Carlos Simón, M.D., Ph.D., Antonio Pellicer, M.D., Ph.D., Juan A. Garcia-Velasco, M.D., Ph.D.

Volume 101, Issue 1, Pages 138-146.e3, January 2014



To use microarray technology to analyze endometrial gene expression after gonadotropin-releasing hormone agonist (GnRH-a) triggering with four different protocols of luteal support in comparison with results obtained after a human chorionic gonadotropin (hCG) trigger.


Prospective, randomized, controlled trial.


University-affiliated private assisted-reproduction center.


25 healthy oocyte donors undergoing controlled ovarian stimulation.


On day of final oocyte maturation, randomization to [1] GnRH-agonist triggering and luteal support with oral estradiol (2 mg/8 hours) and vaginal progesterone (200 mg/12 hours), [2] GnRH-a and a daily dose of 150 IU of recombinant LH from oocyte pickup, [3] GnRH-a and a single bolus of 60 μg of recombinant hCG on oocyte pickup, [4] GnRH-a and three doses of 20 μg of recombinant hCG separated by 48 hours, or [5] 250 μg of recombinant hCG for trigger and standard luteal support; with endometrial biopsy samples collected 7 days after triggering.

Main Outcome Measure(s):

Gene expression using the Endometrial Receptivity Array (ERA) and pathway and network analysis of study groups 1–4 compared with controls (group 5).


The 56 genes in group 1 (25 up-regulated and 31 down-regulated) exhibited altered expression compared with the 36 genes from group 2 (13 up-regulated and 23 down-regulated), 44 from group 3 (28 up-regulated and 16 down-regulated), and 30 (20 up-regulated and 10 down-regulated) from group 4.


Differences were seen in endometrial gene expression related to the type of ovulation trigger and luteal support. However, gene expression after the GnRH-a trigger and modified luteal support adding LH/hCG activity more closely resembles the pattern seen in the hCG group.

Clinical Trial Registration Number:

EudraCT 2011-003250-34.

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