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

Abstract

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).

A retrospective, matched case-control study of recombinant LH versus hMG supplementation on FSH during controlled ovarian hyperstimulation in the GnRH-antagonist protocol

“…The difference in LH levels between the two groups was therefore considered acceptable. Concerning the trigger types, a recent meta-analysis that included both the GnRH agonist and the dual trigger versus the hCG found no significant difference in pregnancy rate ( 28 ). The number of oocytes retrieved was reported to be significantly higher with the dual trigger than hCG alone.…”

The gonadotropins starting dose calculator, which can be adjusted the target number of oocytes and stimulation duration days to achieve individualized controlled ovarian stimulation in Japanese patients

“…In this study, we did not consider the effect of different triggers on the results; however, because it has been reported that there is no difference in the number of oocytes retrieved between hCG and GnRH agonist triggers, it is thought that there is no effect on OSI. 56 , 57 , 58 …”

“…In this study, we did not consider the effect of different triggers on the results; however, because it has been reported that there is no difference in the number of oocytes retrieved between hCG and GnRH agonist triggers, it is thought that there is no effect on OSI. [56][57][58] This is the first study to develop an individualized dosing algorithm for gonadotropins in Japanese patients. Further accumulation of cases is required to develop a standardized calculator that can be used throughout Japan.…”

Reproductive outcomes of dual trigger with combination GnRH agonist and hCG versus trigger with hCG alone in women undergoing IVF/ICSI cycles: a retrospective cohort study with propensity score matching

“…However, Gao et al’s retrospective study and Eftekhar et al’s RCT reported that the number of oocytes retrieved and embryos available were both higher in the dual-trigger group than the hCG trigger-alone group. A 2021 systematic review and meta-analysis similarly found that the two trigger methods were equally effective in terms of pregnancy rate [ 30 ]. At variance with the findings of our study, another meta-analysis reported that although the number of mature oocytes or fertilized oocytes retrieved and the ongoing pregnancy rate were similar, the CPR with dual-trigger was significantly higher than hCG trigger alone [ 31 ].…”