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

Abstract

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.

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

“…In addition, it is important to note that both study groups exceeded expectations for both CPR and LBR compared with our center’s overall success rate in women <35 years old undergoing fresh autologous ET. This finding correlates with multiple research studies that showed that dual trigger improves IVF outcomes ( 38 , 39 , 40 , 41 , 42 , 43 ). Included in these studies was a double-blind, randomized, controlled trial that showed that the use of dual trigger had a significantly higher number of M2 oocytes retrieved, CPR, and LBR compared with those of hCG only trigger ( 40 ).…”

“…In addition, it is important to note that both study groups exceeded expectations for both CPR and LBR compared with our center's overall success rate in women <35 years old undergoing fresh autologous ET. This finding correlates with multiple research studies that showed that dual trigger improves IVF outcomes (38)(39)(40)(41)(42)(43). Included in these studies was TABLE 2 Clinical characteristics of cycles that did and did not achieve a live birth.…”

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

“…The full text of 21 of the 25 remaining articles was reviewed (four were not retrieved). Six articles were included (Schachter et al, 2008;Kim et al, 2014;Decleer et al, 2014;Mahajan et al, 2016;Maged et al, 2021;Haas et al, 2020) in quantitative or meta-analysis.…”

“…Table 4 shows the drugs and dosages used in the different studies for COH (total dose of FSH administered was cited in half of the studies) and the trigger protocol; all used hCG as the conventional trigger. Two studies used 250 µg / 6500 IU of hCG (equivalent total dose); two studies used a higher dose of 10,000 IU of hCG (Maged et al, 2021;Haas et al, 2020); and two studies (Schachter et al, 2008;Decleer et al, 2014) used a dosage of 5000 IU, which was lower than the dose used in the rest of the studies. Kim et al (2014) was the only study in which placebo was added to the conventional hCG trigger.…”

Dual Trigger with Gonadotropin-releasing Hormone Agonist and Human Chorionic Gonadotropin Improves Live Birth Rate for Women with Expected Normal Ovarian Response in Gonadotropin Releasing Hormone Antagonist Cycles: Retrospective Study

“…13 There are meagre number of studies in literature evaluating the effects of dual triggering on IVF outcomes in various subgroups of patients such as hyper-responder, normo-responder or poor-responder women. 5,6,11,[14][15][16][17][18][19][20][21][22][23][24][25] Furthermore, studies reporting live birth rates, the ultimate goal of infertility treatment, in dually triggered women with expected normal ovarian response are even scarcer. 5,6,11,21,23,25 Therefore, current amount of evidence is not adequate to recommend or argue against the use of dual triggering particularly in women with predicted normal ovarian response.…”