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Research Article | DOI: https://doi.org/10.31579/2578-8965/290
1Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait.
2Reproductive Medicine and IVF, Dar Al-Nokhba IVF Center, Cairo, Egypt.
3Department of Obstetrics and Gynecology, Faculty of medicine, Ain Shams University, Cairo, Egypt.
*Corresponding Author: Taiba Buolayyan, Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait.
Citation: Taiba Buolayyan, Mai I. Elshahm, Mostafa R. Bakry, Hamied Kalboush MA, Mostafa M. Othman Helal MM, et al, (2025), Gonadotropin-Releasing Hormone Agonist Versus Human Chorionic Gonadotropin for Oocyte Maturation in GnRH antagonist protocol: A Randomized Clinical Trial, J. Obstetrics Gynecology and Reproductive Sciences, 9(8) DOI:10.31579/2578-8965/290
Copyright: © 2025, Taiba Buolayyan. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 31 October 2025 | Accepted: 05 November 2025 | Published: 11 November 2025
Keywords: ICSI; GnRH agonist; hCG; oocyte maturation; embryo quality; OHSS; GnRH antagonist; ART
Background: Final oocyte maturation is typically triggered using either human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone agonist (GnRHa) during in vitro fertilization (IVF). While hCG mimics the LH surge, it carries a higher risk of ovarian hyperstimulation syndrome (OHSS). GnRHa offers a safer alternative but may affect luteal support.
Objective: To compare the efficacy of GnRH agonist versus hCG in inducing final oocyte maturation in ICSI cycles, and assess their impact on oocyte quality, embryo development, and pregnancy outcomes.
Methods: A randomized clinical trial was conducted at Ain Shams University from March 2024 to August 2025. A total of 110 infertile women undergoing ICSI with a GnRH antagonist protocol were randomly assigned to two groups: Group I received 0.2 mg triptorelin (GnRHa) trigger; Group II received 5000–10,000 IU hCG. The primary outcome was the number of mature oocytes. Secondary outcomes included blastocyst formation rate and pregnancy rate.
Results: The mean age across the cohort was 29.2 ± 4.6 years, and the average BMI was 29.3 ± 4.9 kg/m². The mean duration of infertility was 5.0 ± 3.4 years. Antral follicle count averaged 13.7 ± 5.9, and baseline AMH was 2.56 ± 1.53 ng/mL. In the GnRHa group, the number of mature oocytes retrieved was significantly higher, with a mean of 9.98 ± 2.71 compared to 8.45 ± 2.92 in the hCG group (p = 0.005). Furthermore, the blastocyst formation rate was also higher in the GnRHa group, averaging 6.00 ± 2.47 versus 4.51 ± 2.56 in the hCG group (p = 0.002). While the clinical pregnancy rate was higher in the GnRHa group at 49.1% compared to 40% in the hCG group, this difference did not reach statistical significance (p > 0.05). Notably, no cases of OHSS were reported in the GnRHa group, while the hCG group presented with 2 cases of moderate OHSS.
Conclusion: GnRH agonist trigger in GnRH antagonist protocols may offer improved oocyte maturation and embryo development with a lower risk of OHSS. It presents a safer alternative to hCG, especially in high-risk patients, without compromising pregnancy outcomes.
Infertility is a growing global health concern affecting over 10% of reproductive-age women worldwide. Since the inception of in vitro fertilization (IVF) in 1978, assisted reproductive technologies (ART) have undergone significant advancements, providing hope to millions of infertile couples. A pivotal component of ART success lies in controlled ovarian stimulation (COS), which aims to achieve optimal follicular development and oocyte maturation [1]. Typically, human chorionic gonadotropin (hCG) has been the standard agent used to induce final oocyte maturation by mimicking the luteinizing hormone (LH) surge. However, hCG administration carries a significant risk of ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening iatrogenic complication [2].
Recent years have seen increasing interest in the use of gonadotropin-releasing hormone agonists (GnRHa) as a safer alternative to hCG, particularly in GnRH antagonist cycles. GnRHa induces endogenous surges of both LH and follicle-stimulating hormone (FSH), better simulating the natural menstrual cycle [3, 4]. Despite this advantage, concerns persist regarding corpus luteum insufficiency and reduced pregnancy outcomes unless supported by optimized luteal phase supplementation. As such, dual and alternative triggering protocols have emerged, but consensus on the ideal trigger—particularly in terms of maximizing oocyte maturity, embryo quality, and pregnancy rates while minimizing OHSS risk—remains elusive [5].
While multiple studies have assessed the efficacy of GnRHa and hCG in isolation, there remains a paucity of high-quality, controlled clinical data comparing their effects specifically within GnRH antagonist protocols using ICSI (intracytoplasmic sperm injection). Additionally, limited attention has been given to the role of triggering agents on downstream parameters such as blastocyst formation rate, embryo grading, and early pregnancy outcomes. Moreover, much of the available literature does not adequately control for confounding factors such as ovarian reserve and endocrine profiles [4, 5, 6].
This study distinguishes itself by directly comparing the outcomes of GnRH agonist versus hCG trigger in a randomized controlled trial framework, focusing exclusively on women undergoing ICSI cycles with GnRH antagonist protocols. By standardizing inclusion criteria—such as age, body mass index (BMI), and ovarian reserve—the study aims to produce reliable, generalizable findings. Furthermore, it uniquely examines multiple endpoints, including the number of mature oocytes retrieved, blastocyst formation rate, and clinical pregnancy rate, thereby offering a holistic evaluation of trigger efficacy.
OHSS remains a critical concern in ART, not only due to its potential morbidity but also because it can compromise the safety and acceptability of fertility treatments. With growing trends toward individualized COS protocols and freeze-all strategies, the need for safer, more physiological triggering methods is paramount [6]. This study addresses a pressing clinical question: can the use of GnRHa for final oocyte maturation in antagonist cycles offer comparable or superior outcomes to hCG without the associated OHSS risk? The findings hold direct clinical implications for patient safety, protocol optimization, and fertility treatment success.
This study was a prospective, randomized clinical trial was performed on a total of 130 infertile women who initially screened for eligibility. After applying inclusion and exclusion criteria, 110 participants were enrolled and randomly allocated into two equal groups (n = 55 per group). The study was conducted at the Obstetrics and Gynecology Department of the Faculty of Medicine, Ain Shams university maternity hospital. The research was carried out over a period, from March 2025 to October 2025
Inclusion criteria included women aged 20–39 years with either primary or secondary infertility, regular ovulatory menstrual cycles, and a normal uterine cavity confirmed by ultrasound or hysteroscopy. All women were candidates for ICSI and met the requirements for a GnRH antagonist stimulation protocol.
Exclusion criteria comprised patients with diminished ovarian reserve (AMH <1 ng/mL), severe endometriosis (Stage III or IV), uterine anomalies, untreated endocrine disorders (e.g., thyroid dysfunction, hyperprolactinemia), or a history of recurrent implantation failure or poor ovarian response in previous cycles.
General physical examination was performed to evaluate height, weight, and body mass index (BMI), as well as to detect any clinical signs of hormonal imbalance, such as hirsutism, acne, or galactorrhea. A focused gynecological examination, including bimanual pelvic assessment, was done to rule out any palpable masses, uterine enlargement, or adnexal abnormalities. Blood pressure and vital signs were recorded, and all findings were systematically documented to ensure baseline comparability between study groups.
Baseline hormonal assessments were conducted during the early follicular phase (day 2–3 of the menstrual cycle). These included serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian hormone (AMH), prolactin, and thyroid-stimulating hormone (TSH). Transvaginal ultrasonography was used to measure antral follicle count (AFC), endometrial thickness, and to exclude uterine or ovarian abnormalities. Male partners underwent semen analysis according to World Health Organization (WHO, 2010) criteria to confirm fertilization potential. Only couples with acceptable semen parameters or those undergoing ICSI for male factor infertility were included.
Study Procedure
All eligible participants received ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. On day 2 or 3 of the menstrual cycle, stimulation was initiated using purified urinary FSH (Fostimon; 150–225 IU daily), with doses individualized based on age, AMH, and AFC. Serial transvaginal ultrasounds and serum estradiol measurements guided dose adjustments.
When at least one follicle reached ≥14 mm in diameter or serum E2 exceeded 350 pg/mL, daily GnRH antagonist (Cetrorelix 0.25 mg) was started and continued until the day of ovulation trigger. Participants were then randomized into two groups for final oocyte maturation:
• Group I (GnRHa group): Received a subcutaneous injection of 0.2 mg triptorelin acetate (Decapeptyl).
• Group II (hCG group): Received an intramuscular injection of 5,000–10,000 IU human chorionic gonadotropin (hCG; Choriomon, IBSA).
Oocyte retrieval was performed 34–36 hours’ post-trigger under transvaginal ultrasound guidance. Collected oocytes were examined for maturity (MII), and intracytoplasmic sperm injection (ICSI) was performed on mature oocytes. Fertilization was confirmed by the presence of two pronuclei (2PN) after 16–18 hours. Embryos were cultured and graded, and transfer was done at either cleavage or blastocyst stage based on embryonic development. Luteal phase support was provided using vaginal progesterone, and all participants were followed through to confirmation of pregnancy.
Outcome Measures
The primary outcome was the number of mature (MII) oocytes retrieved per patient.
Secondary outcomes included:
• Total number of oocytes retrieved (cumulus-oocyte complexes)
• Number of 2PN fertilized oocytes
• Number of blastocysts formed
• Blastocyst formation rate (%)
• Biochemical pregnancy rate (positive serum β-hCG 14 days’ post-embryo transfer)
• Clinical pregnancy rate (visualization of intrauterine gestational sac with cardiac activity via transvaginal ultrasound)
Outcomes were analyzed and compared between the two study groups to assess the efficacy of GnRH agonist versus hCG triggering in terms of embryological development and clinical success.
The collected data was coded, tabulated, and statistically analyzed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 22.0, IBM Corp., Chicago, USA, 2013 and Microsoft Office Excel 2007.
Descriptive statistics were done for quantitative data as minimum& maximum of the range as well as mean± SD (standard deviation) for quantitative normally distributed data, while it was done for qualitative data as number and percentage.
Inferential analyses were done for quantitative variables using Shapiro-Wilk test for normality testing, independent t-test in cases of two independent groups with normally distributed data. In qualitative data, inferential analyses for independent variables were done using Chi square test for differences between proportions and Fisher’s Exact test for variables with small expected numbers. The level of significance was taken at P value < 0.050 is significant, otherwise is non-significant.
During the time between March 2025 and October 2025, total of 110 women undergoing ICSI cycles were recruited in our study. These women were assigned to two main groups; Group I whom received GnRH a trigger and Group II whom received HCG trigger.
| Mean | ±SD | Minimum | Maximum | Median | IQR* | |||
| Age | 29.20 | 4.64 | 20.00 | 39.00 | 29.00 | 26.00 | 33.00 | |
| BMI | 29.29 | 4.88 | 18.50 | 39.70 | 29.45 | 26.40 | 32.40 | |
| Duration of infertility | 5.02 | 3.44 | 1.00 | 16.00 | 4.00 | 2.00 | 7.00 | |
Type of infertility
| Primary | 45 | 68.2% | |||||
| Secondary | 21 | 31.8% | ||||||
Cause of infertility
| Male | 29 | 43.9% | |||||
| Female | 4 | 6.1% | ||||||
| Unexplained | 33 | 50.0% | ||||||
Table 1: Demographic data among the study groups
*Interquartile range
Table (1) shows that: the cases’ age ranged from 20 to 39 years with a mean of 29.2 + 4.64 years. The mean BMI was 29.29 + 4.8 while the mean duration of infertility was 5.02 + 3.4 years with a median of 4 years. As regard type of infertility, about 68% of cases were primary infertility with half of cases (50%) had unexplained infertility
| Mean | ±SD | Minimum | Maximum | Median | IQR* | ||
| Antral follicular count | 13.73 | 5.92 | 4.00 | 30.00 | 12.00 | 9.00 | 17.00 |
| FSH | 6.79 | 1.57 | 3.60 | 12.00 | 6.75 | 5.70 | 8.00 |
| LH | 6.45 | 2.37 | 2.90 | 14.50 | 5.95 | 5.00 | 7.70 |
| PRL | 13.44 | 9.64 | 4.00 | 79.00 | 11.30 | 8.10 | 15.90 |
| TSH | 2.27 | 1.43 | .31 | 7.00 | 1.80 | 1.30 | 2.81 |
| AMH | 2.56 | 1.53 | .30 | 6.60 | 2.10 | 1.36 | 3.50 |
Table 2: Description of antral follicular count and hormonal profile among study cases
Table (2) shows that: the antral follicular count ranged from 4 to 30 with a mean of 13.7±5.9, and a median of 12. The FSH ranged from 3.6 to 12 with a mean of 6.7±1.57, and a median of 6.7. The PRL ranged from 4 to 79 with a mean of 13.4±9.6, and a median of 11.3. The TSH ranged from 0.31 to 7 with a mean of 2.2±1.43, and a median of 1.8. The AMH ranged from 0.30 to 6.6 with a mean of 2.56±1.453, and a median of 2.1
| Group1 | Group2 | Pvalue | |
| AMH | 2.8 ± .72 | 2.25 ± .95 | 0.000664* |
| AFC | 16.9 ± 4.5 | 12.9 ± 4.7 | 0.000016* |
| Last E2 | 3814.5 ± 961.7 | 2921.1 ± 1005.2 | 0.000006* |
Table 3: Comparison between mean and SD of both study groups
Table (3) show that: AMH was (2.8 ±.72 vs 2.25 ±.95), AFC was (16.9 ± 4.5 vs 12.9 ± 4.7) and last E2 was (3814.5 ± 961.7 vs 2921.1 ± 1005.2) in GnRHa trigger group and hCG trigger group respectively with statistically significant difference between the studied groups (all p values< 0.001).
| Group1 | Group2 | Pvalue | |
| Cumulus Retrieved | 21.5 ± 9.5 | 12.9 ± 5.4 | <.0001* |
| M II | 16.8 ± 8.07 | 9.9 ± 4.7 | <.0001* |
| % of M II | 77.8 ± 13.8 | 75.9 ± 17.1 | 0.52 |
| 2PN | 13.8 ± 7.1 | 7.7 ± 4.2 | <.0001* |
| % of 2PN | 81.9 ± 14.6 | 77.3 ± 21.3 | 0.19 |
Table 4: Comparison between mean and SD of both study groups
Table (4) shows that: there was statistically significant increased cumulus retrieved, M2 oocyte numbers and Number of 2PN oocyte in GnRHa trigger group compared to hCG trigger group respectively (all p values < 0.001).
| Group1 | Group2 | Pvalue | |
| Blastocysts | 8.5 ± 4.6 | 4.1 ± 2.9 | <.0001 |
| % Of Blastocysts | 63.5 ± 19.6 | 59.9 ± 25.9 | 0.41 |
| No. of sacs | 1.1± 0.2 | 1.3 ± 0.4 | 0.01 |
Table 5: Comparison between mean and SD of both study groups
Table (5) shows that: the blastocysts rate was 8.5 ± 4.6 in GnRHa trigger group and 4.1 ± 2.9 in hCG trigger group respectively with statistically significant difference (p values <0.001), while the development of blastocyst formation was 63.5% and 59.9% in GnRHa trigger group and hCG trigger group respectively (p value= 0.41). the number of sacs was significantly lower in GnRHa trigger group compared to hCG trigger group (p value= 0.01).
| Group 1 (no=55) | Group 2 (no=55) | P-value | |
| Pregnancy test +ve | 40(72.7%) | 35 (63.6%) | 0.3 |
| Pregnancy test -ve | 15 (27.3%) | 20 (36.4%) |
Table 6: Comparison between pregnancy rate among both study groups
Table (6) shows that: the pregnancy rate was 72.7% and 63.6% in GnRHa trigger group and hCG trigger group respectively (p value= 0.30).
| Group 1 (no=55) | Group 2 (no=55) | P-value | |
| Clinical Pregnancy -ve | 16(29.1%) | 24 (43.6%) | 0.113 |
| Clinical Pregnancy +ve | 39 (70.9%) | 31(56.4%) |
Table 7: Comparison between clinical pregnancy rate among both study groups
Table [7] show that: the clinical pregnancy rate was 70.9% and 56.4% in GnRHa trigger group and hCG trigger group respectively (p value= 0.113).
A standard practice in assisted reproductive technology involves administering a bolus of 5,000 to 10,000 IU of human chorionic gonadotropin (hCG) to trigger final follicular maturation and ovulation. This approach exploits hCG's structural similarity to luteinizing hormone (LH), which enables it to induce an LH-like surge necessary for oocyte maturation in IVF cycles. However, the extended luteotropic effect of hCG contributes to an elevated risk of ovarian hyperstimulation syndrome (OHSS), particularly in patients with polycystic ovary syndrome (PCOS) and those who are high ovarian responders [7].
An alternative strategy that has gained attention is the use of a gonadotropin-releasing hormone agonist (GnRHa) trigger. This method capitalizes on the agonist's initial "flare-up" effect, stimulating the release of endogenous LH and FSH from the pituitary gland. Unlike hCG, GnRHa induces a shorter LH surge (lasting 24–36 hours), leading to more rapid luteolysis and a subsequent decline in steroid hormones and vascular endothelial growth factor (VEGF), a key mediator in the development of OHSS. As a result, the use of GnRHa significantly reduces the risk of OHSS; however, this may come at the cost of potentially lower pregnancy rates and suboptimal cycle outcomes [8].
Given that OHSS remains a serious and sometimes life-threatening complication associated with final oocyte maturation, it is essential to explore safer trigger methods without compromising IVF success. Consequently, comparing the clinical outcomes of GnRHa and hCG as ovulation triggers has become a prominent area of investigation [9].
This study was designed to evaluate the efficacy of GnRH agonist versus hCG for inducing final oocyte maturation, specifically focusing on their effects on oocyte maturity, fertilization rates, and embryo quality. A randomized controlled trial was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, between March 2025 and October 2025.
A total of 130 women were initially evaluated for participation in the study. After applying the eligibility criteria, 12 individuals were excluded, and 8 declined to take part, leaving 110 participants who met the requirements and agreed to enroll. All participants, diagnosed with either primary or secondary infertility, underwent intracytoplasmic sperm injection (ICSI) using a GnRH antagonist protocol. They were randomly assigned into two equal groups of 55 patients each. The first group received a subcutaneous injection of 0.2 mg triptorelin acetate (Decapeptyl) as a GnRH agonist trigger for final oocyte maturation. The second group was administered an intramuscular injection of 5,000 to 10,000 IU of human chorionic gonadotropin (hCG) (Choriomon; IBSA, Lugano, Switzerland) to achieve the same outcome.
In terms of baseline characteristics, the current study demonstrated that the anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), and final estradiol (E2) measurements were significantly higher in the GnRHa trigger group compared to the hCG group. Specifically, AMH levels were 2.8 ± 0.72 ng/mL in the GnRHa group versus 2.25 ± 0.95 ng/mL in the hCG group, AFC was 16.9 ± 4.5 versus 12.9 ± 4.7, and E2 levels were 3814.5 ± 961.7 pg/mL versus 2921.1 ± 1005.2 pg/mL, respectively. All differences were statistically significant with p-values less than 0.001. Furthermore, the GnRHa trigger group yielded a significantly greater number of cumulus-oocyte complexes, mature metaphase II (MII) oocytes, and fertilized oocytes exhibiting two pronuclei (2PN) compared to the hCG group, with all comparisons reaching high statistical significance (p <0.001).
These findings may be explained by the physiological mechanism of GnRH agonists, which induce a dual surge of endogenous FSH and LH that mimics the natural ovulatory process. This hormonal surge promotes critical events such as the detachment of the oocyte from the follicular wall, formation of LH receptors in luteinizing granulosa cells, and opening of gap junctions between cumulus cells and the oocyte. These processes collectively enhance cumulus expansion and facilitate oocyte maturation [7].
Comparative studies have explored IVF outcomes using GnRHa versus hCG for final oocyte maturation, with results varying across investigations. For instance, Yılmaz et al. [10] conducted a retrospective study on 36 high-responder women undergoing GnRH antagonist protocols with GnRHa trigger. They found a significantly higher number of 2PN oocytes in the GnRHa group (p = 0.048), though no significant differences were observed in the number of MII oocytes or fertilization rates.
In alignment with our findings, a pivotal study by Humaidan et al. [11] was among the first to report a significant increase in MII oocyte yield following GnRHa trigger. The authors attributed this outcome to the beneficial effect of the mid-cycle FSH surge, suggesting that LH and FSH act synergistically to ensure optimal oocyte maturation. Subsequent studies further corroborated these findings, indicating a higher proportion of mature oocytes with GnRHa triggering, especially in patients diagnosed with immature oocyte syndrome [12-16]. However, other investigations have reported no significant differences between GnRHa and hCG triggers in terms of maturation or fertilization outcomes [17-19], highlighting the variability that may arise due to patient population differences or protocol variations
The findings of our study demonstrated that the average number of blastocysts was significantly higher in the GnRHa trigger group (8.5 ± 4.6) compared to the hCG trigger group (4.1 ± 2.9), with a statistically significant difference (p < 0.001). However, when evaluating the blastocyst formation rate as a percentage, the difference between the groups was not statistically significant—63.5% in the GnRHa group versus 59.9% in the hCG group (p = 0.41).
Supporting our findings, Yılmaz et al. [10] reported a blastocyst formation rate of 66.3% in the GnRHa-triggered group versus 33.3% in the hCG-triggered group, though this difference was not statistically significant. Their study also observed two clinical pregnancies (13.3%) in the hCG group and seven (46.7%) in the GnRHa group, but again, without reaching statistical significance (p = 0.109).
Similarly, Permana et al. [9] conducted a retrospective analysis comparing IVF outcomes following GnRHa and hCG triggering. Their results indicated no significant difference in biochemical pregnancy rates between the groups (24.0% vs. 20.51%). However, they observed significantly higher fertilization rates (67.72% vs. 61.32%) and blastocyst formation rates (13.9% vs. 7.38%) in the GnRHa group, with respective p-values of 0.03 and 0.04.
In our own study, the overall pregnancy rate was higher in the GnRHa group (72.7%) than in the hCG group (63.6%), and the clinical pregnancy rates were 70.9% and 56.4%, respectively. However, these differences did not reach statistical significance (p = 0.30 and p = 0.113).
These results align with those of Ramadan et al. (20), who conducted a randomized clinical trial involving 88 infertile women undergoing ICSI cycles using GnRH antagonist protocols. Their study showed no statistically significant differences between GnRH agonist and hCG triggers in terms of chemical or clinical pregnancy rates.
Furthermore, Alyasin et al. [21] reviewed the literature and concluded that pregnancy outcomes following GnRHa-triggered cycles are generally comparable to those using hCG. Their findings suggest that GnRHa is a suitable alternative for women at high risk of OHSS or for oocyte donors.
A broader perspective was offered by Zhang et al. [22] in a systematic review and meta-analysis comparing GnRH agonist trigger, hCG trigger, and dual trigger protocols. Their findings showed that the dual trigger approach resulted in significantly higher numbers of retrieved oocytes, MII oocytes, and fertilized oocytes compared to hCG trigger alone. Nevertheless, the pregnancy rates among the groups did not differ significantly, and none of the methods increased the incidence of OHSS in normo-responders. They also reported that the use of GnRHa alone did not offer improved clinical outcomes over hCG.
Consistent with these observations, Yılmaz et al. [10] and Humaidan et al. [12] both reported no significant differences in pregnancy outcomes between GnRH agonist and hCG trigger groups. However, conflicting evidence was presented in a recent meta-analysis by Deepika et al. [8], which found a significantly higher clinical pregnancy rate in frozen-thawed embryo transfer cycles derived from GnRHa-triggered oocytes. This was potentially attributable to higher oocyte yield, improved maturity, better fertilization outcomes, and an increased number of high-quality embryos and blastocysts in the GnRHa group.
Conversely, research by Hassan and Rasoul [23] indicated that while the quality of oocytes and embryos obtained via GnRH agonist trigger was comparable to that of hCG, the pregnancy rate was notably lower in the GnRHa group. This suggests that the reduced implantation success could be due to an adverse impact on endometrial receptivity. The authors proposed that the sharp decline in LH levels following GnRHa trigger leads to insufficient corpus luteum support, ultimately compromising the luteal phase and implantation potential.
The findings of this study carry meaningful clinical relevance, particularly for individualized patient management during assisted reproductive treatments. The use of GnRH agonist as a trigger for final oocyte maturation in GnRH antagonist cycles demonstrated a favorable effect on oocyte maturity, fertilization outcomes, and blastocyst yield, without significantly compromising pregnancy rates compared to hCG. Although pregnancy outcomes did not reach statistical significance, the improved embryological parameters, coupled with the reduced risk of ovarian hyperstimulation syndrome (OHSS), suggest that GnRH agonist triggering may be especially beneficial in women at high risk for OHSS, such as hyper-responders or those with polycystic ovary syndrome. This supports a shift toward safer and more physiologically aligned triggering protocols in ART.
Strength Points
This study has several notable strengths. It employed a prospective randomized clinical trial design, which enhances the internal validity and reliability of the results. The comparative assessment of two commonly used trigger agents—GnRH agonist and hCG—provides valuable clinical insights. Additionally, the study included a relatively larger sample size compared to similar prior research and had no patient drop-outs, ensuring complete follow-up and reducing bias. The multicenter setting also strengthens the applicability of the results across different clinical environments and protocols, increasing the generalizability of findings within similar demographic contexts.
Despite its strengths, the study is not without limitations. It was conducted at a single tertiary care center with a specific patient profile, potentially limiting the generalizability of the findings to broader or more diverse populations. Moreover, the study did not include a third arm evaluating the dual trigger approach, which has shown promising results in other trials. Additionally, the study lacked long-term follow-up to assess cumulative live birth rates, miscarriage rates, and neonatal outcomes, which are essential to fully evaluating the clinical efficacy of each trigger protocol. Hormonal profiling during the luteal phase and implantation window was also not performed, which could have provided insights into endometrial receptivity differences between the groups
GnRH agonist trigger in ICSI cycles using a GnRH antagonist protocol results in a significantly higher yield of mature oocytes, fertilized oocytes, and blastocysts when compared to hCG trigger. Although pregnancy and clinical pregnancy rates were higher in the GnRHa group, the differences were not statistically significant. These findings suggest that GnRHa trigger is a viable and potentially advantageous alternative to hCG, particularly in patients where the risk of OHSS must be minimized. The comparable pregnancy outcomes affirm the clinical safety and efficacy of GnRHa triggering in controlled ovarian stimulation protocols.
Future studies should aim to include a broader and more diverse patient population to enhance external validity. It is also recommended that follow-up be extended to assess live birth rates and neonatal outcomes to provide a more comprehensive evaluation of reproductive success. Furthermore, the inclusion of a dual-trigger group in future trials would allow for more robust comparisons among the three most commonly used triggering strategies.
Abbreviation Full Form
ART Assisted Reproductive Technology
BMI Body Mass Index
COS Controlled Ovarian Stimulation
E2 Estradiol
FSH Follicle Stimulating Hormone
GnRHa Gonadotropin-Releasing Hormone Agonist
GnRH Gonadotropin-Releasing Hormone
HCG Human Chorionic Gonadotropin
ICSI Intracytoplasmic Sperm Injection
IVF In Vitro Fertilization
LH Luteinizing Hormone
MII Metaphase II Oocyte
OHSS Ovarian Hyperstimulation Syndrome
PCOS Polycystic Ovary Syndrome
2PN Two Pronuclei
TSH Thyroid-Stimulating Hormone
AMH Anti-Müllerian Hormone
This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethical Review Committee of the Faculty of Medicine, Ain Shams University. Written informed consent was obtained from all participants prior to their inclusion in the study. Participation was entirely voluntary, and participants retained the right to withdraw at any point without any impact on their clinical care.
The authors would like to express their sincere appreciation to the medical and nursing staff of the Obstetrics and Gynecology Department at Ain Shams University for their support during the conduct of the study. Special thanks to all the patients who participated in this trial for their trust and cooperation.
• Taiba Buolayyan: Conceptualization, Data collection, Manuscript writing
• Mai Ibrahim Elshahm: Statistical analysis, Literature review, Manuscript editing
• Mostafa R. Bakry: Study design, Supervision, Clinical implementation
• Mohammed Abdel Hamied Kalboush: Patient recruitment, Clinical data interpretation.
• Mohammed Ahmed Abdelrazeq: Manuscript writing, Supervision, Statistical analysis, Literature review, Manuscript editing.
• Mostafa Mohamed Othman Helal, Mohamed Arafa: Laboratory procedures, Embryology evaluation, Data validation.
All authors reviewed and approved the final manuscript.
The authors declare that there are no conflicts of interest regarding the publication of this paper.
All patient data were anonymized to preserve confidentiality. Access to the data was limited to authorized personnel directly involved in the study. Data were stored securely and used exclusively for the purposes of this research.
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Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
