{"id":22101,"date":"2026-09-19T22:01:35","date_gmt":"2026-09-19T22:01:35","guid":{"rendered":"https:\/\/www.lowcostivf.net\/?p=22101"},"modified":"2026-09-19T22:07:55","modified_gmt":"2026-09-19T22:07:55","slug":"when-is-the-right-time-to-trigger","status":"publish","type":"post","link":"https:\/\/www.lowcostivf.net\/es\/latest-news-from-north-cyprus-ivf-center\/when-is-the-right-time-to-trigger\/","title":{"rendered":"\u00bfCu\u00e1ndo es el momento adecuado para actuar?"},"content":{"rendered":"

La ciencia del tama\u00f1o folicular, la maduraci\u00f3n final del ovocito y la estrategia de doble desencadenante.<\/strong><\/h2>\n\n\n\n

\n Una vez que la cohorte folicular en desarrollo ha alcanzado la etapa adecuada, se administra una inyecci\u00f3n desencadenante para iniciar las etapas finales de la maduraci\u00f3n del ovocito. Este es uno de los pasos m\u00e1s precisos de un ciclo de FIV, ya que el desencadenante promueve la reanudaci\u00f3n de la meiosis ovocitaria y prepara los ovocitos maduros para su extracci\u00f3n.\n<\/p>\n\n\n\n

\n El desencadenante puede contener gonadotropina cori\u00f3nica humana (hCG), un agonista de la GnRH o, en pacientes seleccionadas, una combinaci\u00f3n de ambos, conocida como desencadenante dual. La hCG se une al receptor de LH y proporciona una se\u00f1al similar a la de la LH relativamente prolongada que promueve la maduraci\u00f3n final del ovocito. Un desencadenante agonista de la GnRH, cuando se utiliza en un ciclo con antagonista, estimula la gl\u00e1ndula pituitaria para producir un breve pico end\u00f3geno de LH y FSH.\n<\/p>\n\n\n\n

Un disparador doble<\/strong> Por lo tanto, combina la hCG con un agonista de la GnRH, con el objetivo de beneficiarse tanto del pico end\u00f3geno de LH\/FSH producido por el agonista como de la actividad m\u00e1s sostenida del receptor de LH que proporciona la hCG. Este enfoque se suele considerar en pacientes seleccionadas, especialmente cuando un ciclo anterior ha dado como resultado un n\u00famero de ovocitos maduros (MII) inferior al esperado, un rendimiento ovocitario relativamente bajo en comparaci\u00f3n con el n\u00famero de fol\u00edculos desarrollados u otra evidencia de una maduraci\u00f3n ovocitaria final sub\u00f3ptima.\n<\/p>\n\n\n\n

\n Existe evidencia cl\u00ednica que respalda este enfoque en pacientes seleccionadas. Una revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis de ensayos controlados aleatorizados realizada por Hu et al. (2021), \u201cAgonista de GnRH y hCG (doble desencadenante) versus desencadenante de hCG para la maduraci\u00f3n folicular\u201d, analiz\u00f3 a 1048 pacientes de FIV. En comparaci\u00f3n con la hCG sola, el doble desencadenante se asoci\u00f3 con aproximadamente 1,5 ovocitos recuperados adicionales, un ovocito maduro adicional, m\u00e1s ovocitos fertilizados y embriones utilizables, as\u00ed como una mayor tasa de nacidos vivos en el an\u00e1lisis combinado. Estos hallazgos son alentadores, aunque no implican que el doble desencadenante sea necesario o superior para todas las pacientes.\n<\/p>\n\n\n\n

\u00bfCu\u00e1ndo debemos actuar?<\/strong>\n<\/p>\n\n\n\n

\n El tama\u00f1o del fol\u00edculo es uno de los factores m\u00e1s importantes que se utilizan para determinar cu\u00e1ndo debe desencadenarse la maduraci\u00f3n final del ovocito, pero no existe un di\u00e1metro folicular \u00fanico que sea \u00f3ptimo para todas las mujeres.\n<\/p>\n\n\n\n

\n En un ciclo de estimulaci\u00f3n ov\u00e1rica convencional, generalmente buscamos que la mayor\u00eda de los fol\u00edculos cl\u00ednicamente relevantes tengan un tama\u00f1o aproximado de 16 a 21 mm al momento de administrar la inyecci\u00f3n desencadenante. Esto coincide en gran medida con la pr\u00e1ctica internacional de FIV, donde la inyecci\u00f3n desencadenante suele administrarse una vez que varios de los fol\u00edculos dominantes alcanzan un tama\u00f1o aproximado de 16 a 22 mm.\n<\/p>\n\n\n\n

\n Sin embargo, la relaci\u00f3n entre el tama\u00f1o del fol\u00edculo y la madurez del ovocito es m\u00e1s compleja que simplemente asumir que "cuanto m\u00e1s grande, mejor". El momento \u00f3ptimo puede ser diferente en mujeres con reserva ov\u00e1rica disminuida, antecedentes de mala respuesta ov\u00e1rica o edad reproductiva m\u00e1s avanzada, especialmente cuando existe preocupaci\u00f3n por la luteinizaci\u00f3n u ovulaci\u00f3n prematuras.\n<\/p>\n\n\n\n

\n Un estudio de 2025 titulado \u201cDeterminaci\u00f3n del tama\u00f1o folicular \u00f3ptimo en el momento de la inducci\u00f3n de la ovulaci\u00f3n en pacientes con reserva ov\u00e1rica disminuida sometidas a un ciclo de ICSI\u201d<\/strong> Se examinaron 430 fol\u00edculos individuales de 98 mujeres con reserva ov\u00e1rica disminuida. Los fol\u00edculos de 15 a 17 mm mostraron una tasa de recuperaci\u00f3n de ovocitos de 88,1%, una tasa de madurez MII de 83,3%, una tasa de fertilizaci\u00f3n de 97,1% y una tasa de embriones de alta calidad de 65,4%, resultados generales significativamente mejores que los de los fol\u00edculos de 11 a 14 mm o \u226518 mm. Es importante destacar que la ovulaci\u00f3n prematura se produjo en 13,3% de las pacientes inicialmente programadas, y el tama\u00f1o medio del fol\u00edculo dominante entre aquellas que experimentaron ovulaci\u00f3n prematura fue de 18,6 mm.\n<\/p>\n\n\n\n

\n El mismo estudio hall\u00f3 que las mujeres que experimentaron ovulaci\u00f3n prematura presentaban niveles significativamente m\u00e1s bajos de AMH y m\u00e1s altos de FSH, lo que respalda la idea de que la disminuci\u00f3n de la reserva ov\u00e1rica puede estar asociada con un comportamiento folicular diferente y una posible maduraci\u00f3n final m\u00e1s temprana. Curiosamente, el rango favorable de 15 a 17 mm se observ\u00f3 tanto en mujeres j\u00f3venes como mayores con reserva ov\u00e1rica disminuida, lo que sugiere que la reserva ov\u00e1rica y el comportamiento folicular pueden ser m\u00e1s importantes que un tama\u00f1o universal para los fol\u00edculos al determinar el momento de la inducci\u00f3n de la ovulaci\u00f3n.\n<\/p>\n\n\n\n

\n Lawrenz et al. informaron hallazgos similares. (2024) en el estudio \u201c\u00bfLas mujeres con una reserva ov\u00e1rica muy disminuida que se someten a una fertilizaci\u00f3n in vitro de ciclo natural modificado se benefician de una inducci\u00f3n de la ovulaci\u00f3n m\u00e1s temprana cuando el tama\u00f1o del fol\u00edculo es menor?\u201d <\/strong>En mujeres con una reserva ov\u00e1rica muy disminuida, la inducci\u00f3n de la ovulaci\u00f3n cuando los fol\u00edculos med\u00edan 15 mm o menos redujo significativamente el riesgo de ovulaci\u00f3n prematura y cancelaci\u00f3n del ciclo, en comparaci\u00f3n con esperar a que los fol\u00edculos fueran m\u00e1s grandes. Es importante destacar que la inducci\u00f3n temprana no redujo significativamente la probabilidad de obtener un ovocito maduro. Entre los ciclos en los que se obtuvo un ovocito, las tasas de madurez fueron de aproximadamente 92% para fol\u00edculos de 13-15 mm y 15-17 mm, en comparaci\u00f3n con aproximadamente 59% cuando se permiti\u00f3 que los fol\u00edculos crecieran m\u00e1s all\u00e1 de los 17 mm en su an\u00e1lisis de sensibilidad. Los autores concluyeron que esperar a que los fol\u00edculos superen los 17 mm puede ser desventajoso en algunas mujeres con una reserva ov\u00e1rica muy disminuida.\n<\/p>\n\n\n\n

\n Tambi\u00e9n hay evidencia de que las mujeres con reserva ov\u00e1rica reducida son m\u00e1s susceptibles a un pico prematuro de LH, incluso cuando se est\u00e1 utilizando un antagonista de GnRH. Un estudio titulado \u201cLa disminuci\u00f3n de la reserva ov\u00e1rica predispone a aumentos prematuros de la hormona luteinizante en los ciclos con antagonistas de la hormona liberadora de gonadotropina en la fertilizaci\u00f3n in vitro.<\/strong>Se descubri\u00f3 que los pacientes que experimentaban picos prematuros de LH eran generalmente mayores y ten\u00edan niveles basales de FSH m\u00e1s altos, niveles de AMH m\u00e1s bajos y recuentos de fol\u00edculos antrales m\u00e1s bajos que los pacientes no afectados.\n<\/p>\n\n\n\n

\n Estos hallazgos concuerdan con lo que hemos observado en nuestra pr\u00e1ctica cl\u00ednica. En pacientes seleccionadas, en particular mujeres con reserva ov\u00e1rica disminuida, antecedentes de luteinizaci\u00f3n precoz o historial que sugiera que sus ovocitos maduran con di\u00e1metros foliculares m\u00e1s peque\u00f1os, consideraremos la inducci\u00f3n de la ovulaci\u00f3n un poco antes, a veces cuando la mayor\u00eda de la cohorte folicular cl\u00ednicamente relevante tenga aproximadamente 14-18 mm, en lugar de esperar a que la mayor\u00eda de los fol\u00edculos alcancen el rango convencional m\u00e1s grande.\n<\/p>\n\n\n\n

\n Esto no significa que todas las mujeres mayores o todas las mujeres con reserva ov\u00e1rica disminuida deban someterse a la inducci\u00f3n de la ovulaci\u00f3n precozmente. El momento de la inducci\u00f3n debe ser individualizado. Una inducci\u00f3n demasiado temprana puede resultar en una mayor proporci\u00f3n de ovocitos inmaduros, del mismo modo que una inducci\u00f3n demasiado tard\u00eda puede aumentar el riesgo de luteinizaci\u00f3n u ovulaci\u00f3n prematuras en pacientes susceptibles.\n<\/p>\n\n\n\n

\n Por esta raz\u00f3n, no tomamos la decisi\u00f3n bas\u00e1ndonos \u00fanicamente en el tama\u00f1o del fol\u00edculo. Consideramos el n\u00famero y distribuci\u00f3n de los tama\u00f1os de los fol\u00edculos, <\/em>\n<\/p>\n\n\n\n

edad del paciente,<\/em>
AMH y recuento de fol\u00edculos antrales,<\/em>
respuesta previa a la FIV, duraci\u00f3n de la estimulaci\u00f3n,<\/em>
tasas de madurez de ovocitos previas y,<\/em>
Niveles s\u00e9ricos de estradiol, LH y progesterona.<\/em><\/p>\n\n\n\n

\n El objetivo no es necesariamente producir los fol\u00edculos m\u00e1s grandes posibles, sino identificar el punto en el que la mayor proporci\u00f3n de la cohorte de ovocitos disponible probablemente haya alcanzado la capacidad de desarrollo sin tener que esperar innecesariamente.\n<\/p>\n\n\n\n

Momento de la extracci\u00f3n de \u00f3vulos<\/strong>\n<\/p>\n\n\n\n

\n Una vez administrada la inyecci\u00f3n desencadenante, el momento de la extracci\u00f3n se vuelve crucial. La punci\u00f3n folicular suele programarse aproximadamente 35-36 horas despu\u00e9s, lo que proporciona tiempo suficiente para la maduraci\u00f3n final de los ovocitos, con el objetivo de extraerlos antes de que se produzca la ruptura folicular espont\u00e1nea y la ovulaci\u00f3n.\n<\/p>\n\n\n\n

\n Por este motivo, la inyecci\u00f3n desencadenante debe administrarse exactamente a la hora indicada por el equipo m\u00e9dico. Incluso un ciclo de estimulaci\u00f3n bien dise\u00f1ado puede verse comprometido si la inyecci\u00f3n se administra mucho antes o despu\u00e9s de lo previsto.\n<\/p>\n\n\n\n

\n Por lo tanto, el tama\u00f1o y el momento de aparici\u00f3n de los fol\u00edculos mencionados anteriormente deben considerarse rangos de referencia cl\u00ednica, no reglas fijas. Diferentes pacientes, e incluso distintos ciclos en la misma paciente, pueden presentar patrones diferentes de crecimiento folicular y maduraci\u00f3n ovocitaria. La decisi\u00f3n final sobre el tipo y el momento de la inducci\u00f3n de la ovulaci\u00f3n siempre debe individualizarse seg\u00fan el cuadro cl\u00ednico completo.\n<\/p>\n\n\n\n


Dr. Ahmet Ozyigit,<\/strong>
Doctor en Medicina, M\u00e1ster en Ciencias, Diploma de Posgrado, FAAMM, ABAARM<\/em><\/p>\n\n\n\n

Hospital Elite<\/p>\n\n\n\n

<\/p>\n\n\n\n

Referencias:<\/strong>\n<\/p>\n\n\n\n

\n 1. Hu KL, Wang S, Ye X, Zhang D, Hunt S. Agonista de GnRH y hCG (doble desencadenante) versus desencadenante de hCG para la maduraci\u00f3n folicular: una revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis de ensayos aleatorizados. Reproductive Biology and Endocrinology. 2021;19:78. DOI: 10.1186\/s12958-021-00766-5.\n<\/p>\n\n\n\n

\n 2. Naghshineh E, Ghasemi Tehrani H, Mehrabian F, Mardanian F, Rezaei M.\n<\/p>\n\n\n\n

\n Determinaci\u00f3n del tama\u00f1o folicular \u00f3ptimo en el momento de la inducci\u00f3n de la ovulaci\u00f3n en pacientes con reserva ov\u00e1rica disminuida sometidas a un ciclo de ICSI. Journal of Ovarian Research. 2025;18(1):284. DOI: 10.1186\/s13048-025-01873-2.\n<\/p>\n\n\n\n

\n 3. Lawrenz B, Kalafat E, Ata B, Melado L, Del Gallego R, Elkhatib I, Fatemi H.\n<\/p>\n\n\n\n

\n \u00bfSe benefician las mujeres con reserva ov\u00e1rica severamente disminuida que se someten a fertilizaci\u00f3n in vitro de ciclo natural modificado de una inducci\u00f3n temprana de la ovulaci\u00f3n cuando el tama\u00f1o del fol\u00edculo es menor? Ultrasound in Obstetrics & Gynecology. 2024;64(2):245\u2013252. DOI: 10.1002\/uog.27611.\n<\/p>\n\n\n\n

\n 4. Kochhar PK, Ghosh P. La disminuci\u00f3n de la reserva ov\u00e1rica predispone a aumentos prematuros de la hormona luteinizante en ciclos con antagonistas de la hormona liberadora de gonadotropina en la fertilizaci\u00f3n in vitro. Journal of Human Reproductive Sciences. 2020;13(3):191\u2013195. DOI: 10.4103\/jhrs.JHRS_133_19\n<\/p>","protected":false},"excerpt":{"rendered":"

The Science of Follicle Size, Final Oocyte Maturation, and the Dual Trigger Strategy Once the developing follicular cohort has reached an appropriate stage, a trigger injection is administered to initiate the final stages of oocyte maturation. This is one of the most precisely timed steps of an IVF cycle, as the trigger promotes resumption of oocyte meiosis […]<\/p>","protected":false},"author":2,"featured_media":22102,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54],"tags":[],"class_list":["post-22101","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-infertility-treatment"],"yoast_head":"\nWhen Is the Right Time to Trigger? - North Cyprus IVF<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.lowcostivf.net\/es\/latest-news-from-north-cyprus-ivf-center\/when-is-the-right-time-to-trigger\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"When Is the Right Time to Trigger? - North Cyprus IVF\" \/>\n<meta property=\"og:description\" content=\"The Science of Follicle Size, Final Oocyte Maturation, and the Dual Trigger Strategy Once the developing follicular cohort has reached an appropriate stage, a trigger injection is administered to initiate the final stages of oocyte maturation. This is one of the most precisely timed steps of an IVF cycle, as the trigger promotes resumption of oocyte meiosis […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.lowcostivf.net\/es\/latest-news-from-north-cyprus-ivf-center\/when-is-the-right-time-to-trigger\/\" \/>\n<meta property=\"og:site_name\" content=\"North Cyprus IVF\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/northcyprusivf\/\" \/>\n<meta property=\"article:author\" content=\"https:\/\/www.facebook.com\/northcyprusivf\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-09-19T22:01:35+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-09-19T22:07:55+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.lowcostivf.net\/wp-content\/uploads\/2026\/09\/When-Is-the-Right-Time-to-Trigger.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1312\" \/>\n\t<meta property=\"og:image:height\" content=\"736\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Asst. 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