Dual trigger protocol is an effective in vitro fertilization strategy in both normal and high responders without compromising pregnancy outcomes in fresh cycles

Abstract

Objective: To study the birth rates of normal vs. high responders after dual trigger of final oocyte maturation with gonadotropinreleasing hormone (GnRH) agonist and human chorionic gonadotropin in fresh in vitro fertilization (IVF) cycles in which ovarian stimulation was achieved by a flexible GnRH antagonist protocol. Design: Retrospective cohort study. Setting: University hospital. Patient(s): In women <35 years of age, 290 fresh IVF cycles using the dual trigger protocol with day 5 embryo transfers from January 2013 to July 2018 were included. Cycles excluded were those with preimplantation genetic testing, gestational carriers, donor oocytes, and fertility preservation. Intervention(s): IVF with dual trigger. Main Outcome Measure(s): Clinical pregnancy rate, live birth rate. Result(s): Comparing normal responders, defined as <30 oocytes retrieved, and high responders, defined as R30 oocytes retrieved, the clinical pregnancy rates (67.0% vs. 69.3%, respectively) and live birth rates (60.5% vs. 60.0%, respectively) were not significantly different. No cases of ovarian hyperstimulation syndrome were reported in either group. Conclusion(s):Ovarian stimulation by a flexible GnRH antagonist protocol followed by dual trigger yields comparable outcomes between normal and high responders in fresh IVF cycles.

Evaluation of dual-trigger regimen in improving outcomes for pregnancy in different ovarian respond patients: a retrospective study

“…Chung RK supports dual trigger protocol as an effective in vitro fertilization strategy for high responders without compromising pregnancy outcomes in fresh cycles [22]. And Li S' study demonstrated that dual trigger is capable of preventing severe OHSS while still maintaining an excellent high quality embryo rate in high ovarian responders of GnRH-ant protocols [23].…”

Optimization of assisted reproductive technology outcomes in patients with polycystic ovarian syndrome: updates and unanswered questions

“…Another retrospective analysis by Li et al [39] examined the use of dual trigger using triptorelin and low dose HCG (2000 u) for high responders which included PCOS (37% of the population). The dual trigger was compared to standard HCG dose (10 000 u) and low dose HCG (8000 u).…”

“…One alternative approach is the use of GnRH agonist in combination with low dose of hCG for to allow for CL support via hCG but also reduce risk of OHSS compared to a standard dose hCG trigger. This was examined in a retrospective study of 290 fresh IVF cycles by Chung et al [39]. They compared outcomes after IVF/ICSI with 40 mg leuprolide and 1500 IU hCG in normal responders with <30 oocytes retrieved (215 cycles) and high responders with !30 oocytes retrieved (75 cycles).…”