Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

“…Since the lower pregnancy rates after the GnRH agonist trigger with peak estradiol (E2) <4,000 pg/mL and intensive luteal support were attributed to the lower LH levels on the day of trigger [23], the use of the dual trigger with GnRH agonist and low-dose hCG compared the reproductive outcome with GnRH agonist trigger alone in high responders with peak E2 <4,000 pg/mL. It appears that the dual trigger with low-dose hCG (1,000 IU) and leuprolide acetate (1 mg) combined with intensive luteal support is an effective strategy with only one case of mild OHSS and a significantly higher live birth rate (52.9% vs. 30.9%) (p=.03), implantation rate (41.9% vs. 22.1%) (p<.01) and clinical pregnancy rate (58.8% vs. 36.8%) (p=.03) compared with the GnRH agonist trigger group [12].…”

“…One of the suggested optional methods is the addition of low-dose (1000 to 2500 IU) hCG rescue on the day of GnRH agonist triggering in high responders at risk of OHSS, which has been shown to be effective in achieving acceptable pregnancy rates similar to those obtained after conventional hCG triggering with a very low risk of the syndrome [1,[10][11][12]. Another strategy for final follicular maturation, the concomitant administration of both a GnRH agonist and a standard bolus of hCG (5000-10,000 IU) in normal responders, demonstrated significantly improved implantation, clinical pregnancy and live-birth rates in GnRH-antagonist IVF cycles [15], or a higher number of embryos of excellent quality and cryopreserved embryos [16].…”

Current Approaches to the Use of GnRH Agonist Trigger for Final Oocyte Maturation: Review

“…GnRHa grubunda hiç OHSS görülmez iken; "dual trigger" grubunda sadece bir hafif OHSS görülmüştür. 21 GnRHa TETİKLEME SONRASI hCG İLE MODİFİYE LUTEAL FAZ DESTEĞİ Bu yöntemin temel amacı, GnRHa ile yapılan ovü-lasyon tetiklemesinden sonra erken luteal fazda yetersiz olan endojen LH'yi hCG ile yerine koymaktır. Böylece implantasyon ve ovaryan steroid sentezi için gerekli LH salgısı sağlanmış olmaktadır.…”

“…Araştırmacılar, buna göre; östradiol konsantrasyonu >4.000 pg/mL olanlarda daha önce tanımladıkları LFD'yi ve östradiol konsantrasyonu <4.000 pg/mL olanlarda ise "dual trigger" (GnRHa+1.000 IU hCG)'e ek olarak yoğun LFD'yi vermeyi önermişlerdir. 21 GnRHa tetikleme sonrası LFD için ideal progesteron uygulama yolu tartışmalı bir konudur. Ancak bu hastalarda anormal luteal faz varlığı ve monitörizasyon ihtiyacından dolayı gelecekte muhtemel olarak IM yol tercih edilecektir.…”

A Brief History of GnRH Agonist Trigger and Directions for Future Research

“…Regardless, there are several studies investigating whether dual trigger with simultaneous administration of GnRHa and hCG improves clinical outcome compared to hCG triggering alone. Griffin et al [33] retrospectively reported significantly increased live birth rates with dual trigger despite similar numbers of oocytes being collected following hCG alone. In a RCT involving 211 patients stimulated with a GnRH ant protocol, Schachter et al [34] reported similar number of oocytes collected and fertilization rate with dual trigger and hCG trigger.…”