An Innovative Approach of HCG Trigger with Concurrent 1500 IU HCG and 450 IU FSH Utilization for OHSS Avoidance in High Risk Patients - Is it Superior to Dual Trigger

Abstract

Numerous studies have illustrated composed of with regards to human chorionic Gonadotropins (HCG) dosage in the canonical/ standard HCG trigger (5000-10,000 IU) used for IVF trigger. However avoidance of ovarian hyperstimulation syndrome (OHSS) OHSS is not avoided. This has been further followed by utilizing 2000, 2500, or 3300 IU of HCG dosage for finding minimum efficacious dosage. Subsequently use of gonadotropin releasing hormone agonist (GnRH) trigger was introduced in view of natural LH/FSH surge trigger. Nevertheless, its disadvantage was we could not use it uniformly like in GnRH agonist downregulated cycles. Recently a randomized double blind controlled, non inferiority trial was introduced by Anaya Y., et al. where 1500 IU HCG with concurrent delivery of 450 IU of FSH was observed to be successful in IVF cycles with parallel utilized contrasting with 5000-10,000 IU also for the final oocyte maturation. They found reduced OHSS in this innovative trial. However a larger study is essential with regards to evaluation of embryo production as well as LBR results Although no cycles cancelled one needs to compare this with the recently introduced Dual trigger (HCG + GnRHa trigger) where they observed superiority of results in with regards to embryo formation as well as pregnancy results. One of the modes that might give reason for the enhancement in pregnancy rate is the escalation of receptivity along with implantation in view of the extra-pituitary actions of the GnRH molecule, which is implicated in endometrial receptivity, embryo implantation, and trophoblast invasion. The expression of HOXA-10, possesses a key part in modulating endometrial receptivity, is diminished in endometrial tissues in antagonist cycles as explained by Olieviera., et al.