Dual trigger of final oocyte maturation with a combination of GnRH agonist and hCG versus a hCG alone trigger in GnRH antagonist cycle for in vitro fertilization: A Systematic Review and Meta-analysis

Ding, Nan; Liu, Xingchen; Jian, Qiliang; Liang, Zhongzhen; Wang, Fang

doi:10.1016/j.ejogrb.2017.09.004

Cited by 41 publications

(38 citation statements)

References 21 publications

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“…Our results showed that the use of the dual trigger was associated with a significantly higher number of retrieved COCs, retrieved MII oocytes and retrieved fertilized oocytes. Inconsistent with this result, previous meta‐analyses concluded that there was no significant difference in the number of mature oocytes or fertilized oocytes retrieved between the dual trigger and the hCG‐alone trigger group 17,50 . However, more of the latest RCTs were included in the current study, and the results showed that dual triggering is an effective and safe trigger method that can significantly improve the maturation of oocytes without increasing the risk of OHSS.…”

Section: Discussionsupporting

confidence: 53%

Outcomes comparison of IVF/ICSI among different trigger methods for final oocyte maturation: A systematic review and meta‐analysis

Guo

Chang

et al. 2021

The FASEB Journal

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During the in vitro fertilization treatment, human chorionic gonadotrophin (hCG) is routinely used as a substitute for the natural endogenous LH surge during the final stage of oocyte maturation. However, it does not provide the FSH surge observed in the mid‐cycle of the natural cycle. To date, whether the FSH surge can improve oocyte quality and pregnancy outcomes remains unknown. Randomized controlled trials comparing the following four trigger methods to conventional hCG were examined: GnRH agonist (GnRHa), kisspeptin, GnRHa plus hCG (dual trigger), and FSH plus hCG (FSH co‐trigger). The results showed that the use of dual triggers was associated with a significantly higher number of retrieved cumulus‐oocyte complexes (COCs) (weighted mean difference [WMD] 1.625, 95% CI 0.684‐2.565), retrieved mature oocytes (WMD 0.986, 95% CI 0.426‐1.545) and fertilized (2PN) oocytes (WMD 0.792, 95% CI 0.083‐1.501), compared with the use of hCG. However, there was no significant difference between the two groups in terms of pregnancy rate. The FSH co‐trigger resulted in significantly higher rates of 2PN oocytes retrieved than the hCG trigger (WMD 0.077, 95% CI 0.028‐0.126). Notably, the risk of OHSS did not differ among the three treatment groups compared to that of the hCG group. This review protocol was registered with PROSPERO (CRD 42020194201).

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Section: Discussionsupporting

confidence: 53%

Outcomes comparison of IVF/ICSI among different trigger methods for final oocyte maturation: A systematic review and meta‐analysis

Guo

Chang

et al. 2021

The FASEB Journal

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“…Ding et al ( 179 ) conducted a meta-analysis including 527 women from four eligible RCTs to investigate the efficacy of the dual trigger in comparison with hCG alone [Schachter et al ( 177 ) in 2008, Decleer et al ( 178 ) in 2014, Kim et al ( 180 ) in 2014, Mahajan et al ( 181 ) in 2016]. The analysis did not demonstrate any difference in the number of oocytes, mature oocytes, zygotes, or implantation rate, although it did find an increase in the pregnancy rate in the GnRHa-supplemented group as compared with hCG alone (relative risk, 1.55; 95% CI, 1.17 to 2.06) ( 179 ). In summary, additional FSH exposure is suggested to enhance oocyte maturation, although LH/hCG play a dominant role and the additional impact of FSH is likely to be small.…”

Section: Endocrine Requirements For Oocyte Maturation and Ovulationmentioning

confidence: 99%

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

2018

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Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication “ovarian hyperstimulation syndrome” (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.

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“…However, in the four studies included, there was heterogeneity in the criteria used for triggering, different doses were used in the trials that used only hCG triggering and different agonists were used concomitantly with hCG for dual triggering in the studies ( 158 ). In another systematic review and meta−analysis of four studies in 527 women undergoing IVF treatment, women receiving a dual trigger had a significantly higher pregnancy rate compared with those receiving hCG alone (RR 1.55 [95% CI 1.17, 2.06]) ( 164 ). However, there was no significant difference in the number of oocytes retrieved or implantation rates between the groups.…”

Section: Results Of the Consensus And Actionable Recommendations (Including Supportive Evidence)mentioning

confidence: 99%

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

et al. 2021

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BackgroundA Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment.MethodsTen experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%.ResultsEighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support.ConclusionsThis Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.

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Dual trigger of final oocyte maturation with a combination of GnRH agonist and hCG versus a hCG alone trigger in GnRH antagonist cycle for in vitro fertilization: A Systematic Review and Meta-analysis

Cited by 41 publications

References 21 publications

Outcomes comparison of IVF/ICSI among different trigger methods for final oocyte maturation: A systematic review and meta‐analysis

Outcomes comparison of IVF/ICSI among different trigger methods for final oocyte maturation: A systematic review and meta‐analysis

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

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