Dual trigger vs. Conventional trigger outcomes in In Vitro Fertilization. Systematic review and meta-analysis

González, Virginia González; Triana, Alejandra Mayoral; Serrano-García, Irene; Nieto, Sara Osado; Urrutia, Marta Calvo; García, Ignacio Cristóbal; Gastañaga-Holguera, Teresa

doi:10.5935/1518-0557.20220035

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…Dual trigger is a strategy initially used as rescue treatment to improve implantation rates and the overall reproductive outcomes in IVF patients who received GnRH-a alone for ovulation triggering [ 72 , 73 , 74 ]. However, the co-administration of the hCG to GnRH-a trigger increases OHSS risk [ 75 ].…”

Section: Resultsmentioning

confidence: 99%

Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments

Palomba,

Costanzi,

Nelson

et al. 2023

IJMS

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Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for the prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-analyses of randomized controlled trials (RCTs) and assess and grade their efficacy and evidence base. The best available evidence for each specific intervention was identified, analyzed in terms of safety/efficacy ratio and risk of bias, and graded using the Oxford Centre for Evidence-Based Medicine (CEBM) hierarchy of evidence. A total of 15 interventions to prevent OHSS were included in the final analysis. In the IVF population not at a high risk for OHSS, follitropin delta for ovarian stimulation may reduce the incidence of early OHSS and/or preventive interventions for early OHSS. In high-risk patients, inositol pretreatment, ovulation triggering with low doses of urinary hCG, and the luteal phase administration of a GnRH antagonist may reduce OHSS risk. In conclusion, even if not supported by systematic reviews with homogeneity of the RCTs, several treatments/strategies to reduce the incidence and severity of OHSS have been shown to be promising.

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Section: Resultsmentioning

confidence: 99%

Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments

Palomba,

Costanzi,

Nelson

et al. 2023

IJMS

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“…In our study, there was a notable increase in the quantity of mature oocytes and highquality embryos. According to a recent meta-analysis conducted by Gonzalez, it was found that the dual trigger group exhibited significantly higher rates of retrieved oocytes and clinical pregnancy when compared to other groups [26].…”

Section: Discussionmentioning

confidence: 99%

In Vitro Fertilization Outcomes With a Dual Trigger in Normoresponders in Antagonist Cycles

Cevher Akdulum,

Arık,

Demirdağ

et al. 2023

Cureus

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To evaluate whether the dual trigger of ovulation with a gonadotropin-releasing hormone (GnRH) agonist and the standard dose of recombinant human chorionic gonadotropin (hCG) (dual trigger) is better than hCG alone in in vitro fertilization (IVF) cycles of patients who responded well to ovarian stimulation. MethodsBetween January 2013 and December 2021, 5593 antagonist cycles of patients were reviewed. This study included women who had an antral follicle count of 5 or more and exhibited a normoresponse to ovarian stimulation using the GnRH antagonist protocol, as determined by the follicular output rate (FORT). The primary outcome indicators consisted of the quantities of retrieved oocytes and mature oocytes. The secondary outcome markers included live birth rates, clinical pregnancy rates, and continued pregnancy rates. ResultsA total of 1244 normoresponder women who met the inclusion criteria were identified from the scanned files and subsequently enrolled in the GnRH antagonist protocol. A total of 383 cycles were observed in the group that was given the standard hCG trigger while 861 cycles were observed in the group that was given the dual trigger. The number of mature oocytes and top-quality embryos was significantly higher in the dual trigger group. The maturation rate in the hCG group was 74.8% while it was 76.9% in the dual trigger group (p=0.018). The dual trigger group exhibited an ongoing pregnancy rate of 37.6%, whereas the hCG group had a rate of 30.1% (p = 0.02). The dual trigger group exhibited a slightly higher live birth rate (34.3% vs 29.2%, p = 0.11), although this difference did not reach statistical significance. ConclusionDual trigger of ovulation was superior to hCG alone in terms of the number of mature oocytes yielded, top quality of embryos, maturation rates, and ongoing pregnancy in IVF cycles of normoresponders having ovarian stimulation on the GnRH antagonist protocol.

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“…However a larger study is essential with regards to evaluation of embryo production as well as LBR results [16]. Gonzalez-Gonzalez V., et al [18]…”

Section: Discussionmentioning

confidence: 99%

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

Kaur,

Allahbadia,

Singh

2023

Act Sci wom hea

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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.

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Dual trigger vs. Conventional trigger outcomes in In Vitro Fertilization. Systematic review and meta-analysis

Cited by 6 publications

References 12 publications

Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments

Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments

In Vitro Fertilization Outcomes With a Dual Trigger in Normoresponders in Antagonist Cycles

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

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