Lupron trigger instead of HCG

Question:
My RE gave me a lupron trigger instead of my usual HCG or ovidrel trigger. It concerns me because when I read about lupron it is a ovulation suppressor. Did I ovulate? I took two lupron shots 12 hrs a part. I am now on progesterone supp. and patch along with a estrogen pill 3 x daily.
　
I was on 150 gonal-f for 9 days and then 75 for day 10. I also used ganarelix starting day 5 of stim. My E2 was higher than my RE liked and he wsa worried about OHSS. It was an IUI cycle. I OHSS in 2004 when I got preg. with my twins.
　　
I love my RE, but I just can not find much info on lupron trigger so I am a little concerned.

Answer:
Hello Michelle from the U.S.,
　　
The Lupron trigger has been used extensively and written about extensively in Europe. It is better than HCG with hyperstimulation because it has a shorter duration, reducing the chances of developing OHSS. I use it with my PCO patients who have a tendency to hyperstimulate and are at higher risk of OHSS. As a result, I have not had a patient with OHSS in years. I only given one injection, not two. Lupron used daily or in the higher doses can certainly suppress the ovary. It works indirectly but has the same effect as the Ganerelix. In low doses, it mimics HCG and triggers ovulation. I love the Ganerelix-Lupron protocol.
　
My biggest concern with your story is why you are following an IVF protocol for an IUI cycle? You are getting stimulated way too much. With IUI, we only want up to 3 ovulatory sized follicles. If you ovulate more than that, you will be at high risk of a super-multiple pregnancy (not good). Also, if you stimulated so much that your RE would be worried about hyperstimulation then you should not be completing the cycle. It should be cancelled, again because of the high risk of a super-multiple. OHSS occurs when the Estradiol level is greater than 4000 and you have more than 20 follicles. that's way too much for an IUI cycle!!!　
　
I think you have good reason to be concerned.
　　
Sincerely,
　　
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/　
Monterey, California, U.S.A.

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