Dual trigger with gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves oocyte yield in normal responders on GnRH-antagonist cycles

Abstract

Objective During in vitro fertilization (IVF) cycles, final oocyte maturation is usually triggered by human Chorionic Gonadotropin (hCG) for its known effect in mimicking Luteinizing Hormone (LH) surge; however, with the widespread use of the ‘antagonist protocol’, Gonadotropin Releasing Hormone agonist (GnRHa) is being more commonly employed as a trigger in order to minimize or eliminate the risk of ovarian hyper-stimulation syndrome (OHSS). Many studies proved its efficacy in inducing oocyte maturation and its safety in preventing OHSS in high-risk groups. Moreover, some studies showed that GnRHa trigger may improve oocyte yield. This study aimed to further explore any beneficial effect of adding GnRHa to hCG (dual trigger) on oocyte yield and fertilization rate in normal responder women. Methods We retrospectively reviewed and analyzed the data from 127 patients on antagonist protocol (67 dual trigger and 60 HCG trigger). Results The number of total oocytes, the number of MII oocytes and the number of fertilized oocytes were all significantly higher with the dual trigger protocol compared to hCG-only trigger. However, there is no significant difference in clinical pregnancy rate. Conclusions Using the dual trigger improved the number and quality of oocytes, and the fertilization rate in normal responders.

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

“…In other studies, Eser A [18] believes that dual trigger of oocyte maturation with GnRHa and normal dose HCG in poor responders do not demonstrate improved oocyte maturation, clinical pregnancy, and ongoing pregnancy rates. Both Şükür YE and Albeitawi S both support better results of the dual trigger in normal responders [19,20], but Gao F's study believes that the dual trigger was not superior to the HCG alone trigger in terms of the cumulative live-birth rate [21].…”

“…The trigger generally refers to Human Chorionic Gonadotropin (HCG) and Gonadotropin-releasing Hormone antagonist (GnRHa), which can mimic physiological Luteinizing Hormone (LH) peaks and trigger ovulation at approximately 36-40 hours later. However, the half-life of HCG is longer than that of LH and the a nity between HCG and receptor is stronger than that of LH, which are prone to cause ovarian hyperstimulation syndrome (OHSS), a kind of iatrogenic disease [2]. OHSS often occurs in luteal phase after ovulation induction or early pregnancy.…”

Dual trigger and the impact on oocyte quality and embryo development: a Brazilian cohort

“…However, in the conventional controlled ovarian stimulation (COS) regimen, it is not possible to use LH as ovulation triggering since it has a short half-life in plasma (< 60 minutes) ( Casper, 2015 ; Haas et al ., 2020 ; Tan et al ., 2020 ; Hu et al ., 2021 ). Therefore, in COS, final follicular maturation is triggered by human chorionic gonadotropin (hCG) which acts as a surrogate to the naturally occurring LH surge ( Ding et al ., 2017 ; Zhang et al ., 2017 ; Ali et al ., 2020 ; Ben-Haroush et al ., 2020 ; Haas et al ., 2020 ; Albeitawi et al ., 2022 ; Yan et al ., 2022 ), allowing the process of final oocyte maturation, and subsequent implantation with appropriate luteal phase support in fresh transfer cycles ( Tan et al ., 2020 ). However, the COS protocol itself, its duration, the type, and drugs dosage are clinician-dependent factors that might affect oocyte and embryo quality ( Gurbuz et al ., 2016 ).…”

“…Human Chorionic Gonadotropin is routinely used for inducing LH surge and consequently final oocyte maturation ( Oliveira et al ., 2016 ). However, triggering with hCG can have as a serious side effect the occurrence of Ovarian Hyperstimulation Syndrome (OHSS), secondary to prolonged stimulatory effects on the corpus luteum ( Ding et al ., 2017 ; Albeitawi et al ., 2022 ).…”

“…In COS, GnRHa can be used as an effective and save alternative to hCG to release both FSH and LH that are critical for final oocyte maturation ( Zhang et al ., 2017 ; Zhang et al ., 2021 ; Eser et al ., 2018 ; Haas et al ., 2020 ; Lan et al ., 2020 ; Z hu et al ., 2021 ; Albeitawi et al ., 2022 ; Halim & Lubis, 2022 ).…”