Efficacy of Kisspeptin-54 to Trigger Oocyte Maturation in Women at High Risk of Ovarian Hyperstimulation Syndrome (OHSS) During In Vitro Fertilization (IVF) Therapy

• Published in: The journal of clinical endocrinology and metabolism Vol. 100; no. 9; pp. 3322 - 3331
• Main Authors: Abbara, Ali, Jayasena, Channa N., Christopoulos, Georgios, Narayanaswamy, Shakunthala, Izzi-Engbeaya, Chioma, Nijher, Gurjinder M. K., Comninos, Alexander N., Peters, Deborah, Buckley, Adam, Ratnasabapathy, Risheka, Prague, Julia K., Salim, Rehan, Lavery, Stuart A., Bloom, Stephen R., Szigeti, Matyas, Ashby, Deborah A., Trew, Geoffrey H., Dhillo, Waljit S.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.09.2015; Endocrine Society
• Subjects: Adult; Drug Therapy, Combination; Embryos; Female; Fertilization in Vitro - methods; Follicle Stimulating Hormone - adverse effects; Follicle Stimulating Hormone - therapeutic use; Follicle-stimulating hormone; Follicles; Gonadotropin-releasing hormone; Gonadotropin-Releasing Hormone - antagonists & inhibitors; Hormone Antagonists - therapeutic use; Humans; In vitro fertilization; Infertility; Infertility, Female - therapy; Kiss1 protein; Kisspeptins - therapeutic use; Maturation; Oocytes; Original; Ovarian hyperstimulation syndrome; Ovarian Hyperstimulation Syndrome - chemically induced; Ovarian Hyperstimulation Syndrome - prevention & control; Ovaries; Ovulation Induction - methods; Pregnancy; Risk Factors
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2015-2332

Context:In vitro fertilization (IVF) treatment is an effective therapy for infertility, but can result in the potentially life-threatening complication, ovarian hyperstimulation syndrome (OHSS).Objective:This study aimed to investigate whether kisspeptin-54 can be used to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS.Setting and Design:This was a phase 2, multi-dose, open-label, randomized clinical trial of 60 women at high risk of developing OHSS carried out during 2013–2014 at Hammersmith Hospital IVF unit, London, United Kingdom.Intervention:Following a standard recombinant FSH/GnRH antagonist protocol, patients were randomly assigned to receive a single injection of kisspeptin-54 to trigger oocyte maturation using an adaptive design for dose allocation (3.2 nmol/kg, n = 5; 6.4 nmol/kg, n = 20; 9.6 nmol/kg, n = 15; 12.8 nmol/kg, n = 20). Oocytes were retrieved 36 h after kisspeptin-54 administration, assessed for maturation, and fertilized by intracytoplasmic sperm injection with subsequent transfer of one or two embryos. Women were routinely screened for the development of OHSS.Main Outcome Measure:Oocyte maturation was measured by oocyte yield (percentage of mature oocytes retrieved from follicles ≥ 14 mm on ultrasound). Secondary outcomes include rates of OHSS and pregnancy.Results:Oocyte maturation occurred in 95% of women. Highest oocyte yield (121%) was observed following 12.8 nmol/kg kisspeptin-54, which was +69% (confidence interval, −16–153%) greater than following 3.2 nmol/kg. At all doses of kisspeptin-54, biochemical pregnancy, clinical pregnancy, and live birth rates per transfer (n = 51) were 63, 53, and 45%, respectively. Highest pregnancy rates were observed following 9.6 nmol/kg kisspeptin-54 (85, 77, and 62%, respectively). No woman developed moderate, severe, or critical OHSS.Conclusion:Kisspeptin-54 is a promising approach to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS.