Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Kasum, Miro; Kurdija, Kristijan; Orešković, Slavko; Čehić, Ermin; Pavičić-Baldani, Dinka; Škrgatić, Lana

doi:10.1080/09513590.2016.1193141

Cited by 25 publications

(13 citation statements)

References 23 publications

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“…As in our study, several trials have also studied the use of GnRH agonists in dual trigger protocols and in high responders demonstrated better live‐birth and ongoing pregnancy rates and lower risk of ovarian hyperstimulation syndrome 18 . Dual triggering also improved ongoing pregnancy rates in normal responders 19 and was successful in women suffering from empty follicle syndrome 20 …”

Section: Discussionsupporting

confidence: 65%

Comparative study between single versus dual trigger for poor responders in GnRH‐antagonist ICSI cycles: A randomized controlled study

Maged

Ragab

Shohayeb

et al. 2020

Intl J Gynecology & Obste

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Objective To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin‐releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the number of retrieved oocytes and clinical pregnancy rate in poor responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF‐ICSI) cycles using a GnRH‐antagonist protocol. Methods A randomized controlled trial included poor ovarian responders indicated for ICSI using a GnRH‐antagonist protocol. They were divided equally into two groups: group I received 10 000 units of hCG plus 0.2 mg of triptorelin while group II received 10 000 units of hCG only for triggering of ovulation. The primary outcome parameter was the number of oocytes retrieved. Secondary outcomes included metaphase II oocytes number, cancellation rate, number of obtained embryos, chemical and clinical pregnancy rates. Results One hundred and sixty women were included in the study, with 80 women in each treatment group. Dual triggering was associated with higher number of retrieved oocytes (5.3 ± 1.9 vs 4.5 ± 2.4, P=0.014), metaphase II oocytes (3.8 ± 1.4 vs 3.1 ± 1.7, P=0.004), total and grade 1 embryos (2.7 ± 1.1 and 2.3 ± 1.0 vs 1.9 ± 1.2 and 1.1 ± 0.2, P=0.001 and 0.021 respectively), and transferred embryos (2.2 ± 0.9 vs 1.6 ± 0.9, P=0.043, and lower cancellation rate (7.5% vs 20%, P=0.037) compared with single triggering. There were significantly higher chemical (25% vs 11.3%, P=0.039) and clinical (22.5% vs 8.8%, P=0.028) pregnancy rates in women with dual triggering compared with those with single triggering. Conclusion Dual triggering is associated with better IVF outcome in poor responders compared with single trigger. Clinical trial registration NCT04008966.

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Section: Discussionsupporting

confidence: 65%

Comparative study between single versus dual trigger for poor responders in GnRH‐antagonist ICSI cycles: A randomized controlled study

Maged

Ragab

Shohayeb

et al. 2020

Intl J Gynecology & Obste

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“…The concept of the "double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 hours prior to ovum pickup, respectively. 56 Double trigger prolongs the time between ovulation trigger and ovum pickup, aiming to overcome any existing granulosa cell dysfunction, facilitating cumulus cell expansion and meiotic maturation and thus results in retrieving more mature oocytes and plays role in patients with abnormal follicular maturation despite adequate response to COH.…”

Section: Double Triggermentioning

confidence: 99%

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

Malhotra¹,

Malhotra²,

Bora³

et al. 2020

Journal of South Asian Federation of Obstetrics and Gynaecology

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Human chorionic gonadotropin (hCG) has been the gold standard in the induction of final oocyte maturation since the pioneer days of in vitro fertilization (IVF). But owing to its long half-life, it leads to increased risk of ovarian hyperstimulation syndrome (OHSS). Trigger of GnRH agonist is a more physiological trigger, effective, and safe, as it significantly reduces or eliminates risk of OHSS. Newer options of dual trigger and double trigger are discussed in this review, which can be used as modified luteal phase support in patients with expected suboptimal oocyte maturation. Newer pharmaceutical options such as Kissepeptins, key in central regulation of neuroendocrine system, and GnRH release need more studies before being implemented in general practice. This review includes details of various trigger options for final oocyte maturation and about combination of trigger options aiming safe and effective outcomes.

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“…In normal responders, dual trigger also improves clinical outcomes compared to the standard dosage of hCG trigger in GnRH antagonist IVF cycles [45]. The dual trigger concept has also been used in poor responders, yielding better oocyte retrieval rates than GnRH-a alone [32,47]. Furthermore, the dual trigger may be clinically relevant in cases of empty follicle syndrome and a history of a high number of immature oocytes retrieved on the ovum pickup day [32].…”

Section: Dual Triggeringmentioning

confidence: 99%

Ovarian manipulation in ART: going beyond physiological standards to provide best clinical outcomes

Ortega

García-Velasco

Pellicer

2018

J Assist Reprod Genet

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Current knowledge on ovarian physiology has challenged the traditional concept of folliculogenesis, creating the basis for novel ovarian stimulation protocols in assisted reproduction technology. The purpose of this review was to evaluate the efficacy of novel clinical interventions that could aid clinicians in individualizing their protocols to patients' characteristics and personal situations. We conducted a literature review of the available evidence on new approaches for ovarian stimulation from both retrospective and prospective studies in the PubMed database. Here, we present some of the most important interventions, including follicle growth in the gonadotropin-independent and dependent stage, manipulation of estradiol production throughout ovarian stimulation, control of mid-cycle gonadotropin surges, and luteal phase support after different stimulation protocols and trigger agents. The latest research on IVF has moved physicians away from the classical physiology, allowing the development of new strategies to decouple organ functions from the female reproductive system and challenging the traditional concept of IVF.

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Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Cited by 25 publications

References 23 publications

Comparative study between single versus dual trigger for poor responders in GnRH‐antagonist ICSI cycles: A randomized controlled study

Comparative study between single versus dual trigger for poor responders in GnRH‐antagonist ICSI cycles: A randomized controlled study

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

Ovarian manipulation in ART: going beyond physiological standards to provide best clinical outcomes

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