Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols

Li, Saijiao; Zhou, Danni; Yin, Tailang; Xu, Wangming; Xie, Qingzhen; Cheng, Dan; Yang, Jing

doi:10.18632/oncotarget.23916

Cited by 18 publications

(16 citation statements)

References 23 publications

(23 reference statements)

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“…We could not find any report in the literature that advocates for the use of 2,000 IU hCG for ovulation trigger. Such low doses are only used for dual trigger with GnRh analogs to optimize clinical outcomes for high ovarian responders in GnRH-antagonist protocols [22]. Most cases of FEFS can be avoided by confirming that the patient self-administered her prescribed hCG dose by measuring the amount of β-hCG in her blood the morning after the hCG was administered, as is the practice in our unit and as advocated by others [9].…”

Section: Discussionmentioning

confidence: 94%

Successful Oocyte Retrieval, Fertilization, and Clinical Pregnancy with Low Serum β-hCG on the Day of Oocyte Collection: A Reappraisal of the Definition of the Empty Follicle Syndrome

Velde

Chatzicharalampous

Awonuga

2020

Case Reports in Obstetrics and Gynecology

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Objective. To describe a case of successful oocyte retrieval, fertilization and clinical pregnancy despite very low β-hCG level, twelve hours after ovulation trigger. Design. Case report. Setting. Academic medical center. Patient. A 38-year-old patient inadvertently administered 2,000 IU hCG for final oocyte maturation; serum hCG twelve hours later was 16 IU/L. Interventions. Effort to obtain and administer a booster dose of hCG over the next twenty-seven hours failed. Main Outcome. Successful oocyte retrieval. Results. Fourteen oocytes were retrieved of which twelve were in metaphase II and nine fertilized after intracytoplasmic sperm injection (ICSI). Of these, eight embryos survived to day 5 and were subjected to preimplantation genetic screening (PGS) by comparative genomic hybridization (CGH). Results were available the next day, three of the embryos were euploid and one was transferred on day 6. Pregnancy was confirmed twelve days later and currently the patient has an ongoing singleton intrauterine pregnancy. Conclusion. Reproductive Endocrinology and Infertility specialists should be aware that final oocyte maturation could occur following injection of a lower dose of hCG with excellent fertilization rate and embryo development.

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Section: Discussionmentioning

confidence: 94%

Successful Oocyte Retrieval, Fertilization, and Clinical Pregnancy with Low Serum β-hCG on the Day of Oocyte Collection: A Reappraisal of the Definition of the Empty Follicle Syndrome

Velde

Chatzicharalampous

Awonuga

2020

Case Reports in Obstetrics and Gynecology

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“…Previous retrospective studies indicate that dual trigger can reduce the OHSS rate in predicted high responders [ 32 , 33 ]. Because most trials included in our study enroll women with a moderate response, whether the dual trigger is more applicable in high or moderate or poor responders requires further confirmation [ 10 , 32 , 33 ]. Additionally, no consensus has been reached towards the best dose of GnRH agonist and hCG in the dual trigger treatment.…”

Section: Discussionmentioning

confidence: 99%

GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials

Wang

et al. 2021

Reprod Biol Endocrinol

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Background Traditionally, final follicular maturation is triggered by a single bolus of human chorionic gonadotropin (hCG). This acts as a surrogate to the naturally occurring luteinizing hormone (LH) surge to induce luteinization of the granulosa cells, resumption of meiosis and final oocyte maturation. More recently, a bolus of gonadotropin-releasing hormone (GnRH) agonist in combination with hCG (dual trigger) has been suggested as an alternative regimen to achieve final follicular maturation. Methods This study was a systematic review and meta-analysis of randomized trials evaluating the effect of dual trigger versus hCG trigger for follicular maturation on pregnancy outcomes in women undergoing in vitro fertilization (IVF). The primary outcome was the live birth rate (LBR) per started cycle. Results A total of 1048 participants were included in the analysis, with 519 in the dual trigger group and 529 in the hCG trigger group. Dual trigger treatment was associated with a significantly higher LBR per started cycle compared with the hCG trigger treatment (risk ratio (RR) = 1.37 [1.07, 1.76], I2 = 0%, moderate evidence). There was a trend towards an increase in both ongoing pregnancy rate (RR = 1.34 [0.96, 1.89], I2 = 0%, low evidence) and implantation rate (RR = 1.31 [0.90, 1.91], I2 = 76%, low evidence) with dual trigger treatment compared with hCG trigger treatment. Dual trigger treatment was associated with a significant increase in clinical pregnancy rate (RR = 1.29 [1.10, 1.52], I2 = 13%, low evidence), number of oocytes collected (mean difference (MD) = 1.52 [0.59, 2.46), I2 = 53%, low evidence), number of mature oocytes collected (MD = 1.01 [0.43, 1.58], I2 = 18%, low evidence), number of fertilized oocytes (MD = 0.73 [0.16, 1.30], I2 = 7%, low evidence) and significantly more usable embryos (MD = 0.90 [0.42, 1.38], I2 = 0%, low evidence). Conclusion Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger. Trial registration CRD42020204452.

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“…A bulk of evidence have suggested that dual trigger haveseveralsigni cant advantages over hCG or GnRHa protocol,such as better luteal phase supportand lower risk of OHSSin normal and/or high respond patients [6][7][8]. More importantly, some reports showed that dual trigger may improve oocyte retrieval and maturation, cultural outcome, as well as embryo implantation in subjects with normal ovarian reservation [9,10].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis on the Clinical Efficiency of Dual Trigger During Vitro Fertilization and Embryo Transfer (IVF-ET) Treatment for Women with Diminished Ovarian Reserve

Zhang

Huang

et al. 2022

Preprint

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Background: Due to poor number and quality of oocytes, the reproductive prognosis of diminished ovarian reserve (DOR) patients is obstinately disapproving. This study will compare the effects of double trigger and hCG trigger on the culture outcome and implantation outcome during the IVF treatment for DOR patients. Methods: a total of 857 controlled ovarian stimulation (COS) cycles and 366 frozen embryo transfer (FET) cycles were included in this study. The difference in retrieval cancellation, oocyte retrieval, number of oocytes, maturation oocytes, fertilization, embryos were evaluated between the two groups in the COS dataset, while implantation, clinical pregnancy, ongoing pregnancy, and spontaneous abortion were analyzed based on FET dataset. To robustly evaluate the marginal effect of the study factor as well as other covariates, a cluster-weighted GEE model was exploited to fit the uniqueness of IVF-ET data.Results: Neither the retrieval outcome, nor cultural or implantation outcomes were improved after dual-trigger. The OR values were 1.08 (95% CI: 0.41 ~2.78) for retrieval cancellation, 1.33 (95% CI: 0.89 ~2.00) for oocyte harvest, 0.99 (95%: 0.97 ~1.02) for oocyte maturation, 1.03 (95%CI: 0.94 ~1.12) for fertilization, 1.04 (95%CI: 0.94 ~1.15) for viable embryo, and 1.03 (95%CI: 0.88 ~1.19) for top quality embryo. As to the transfer outcome, no difference was identified between the two groups, with the ORs 0.90 (95%CI: 0.62 ~1.30) for implantation and 0.97 (95%CI: 0.56 ~1.69) for clinical pregnancy. This insignificance remained unchanged after adjusting for the covariates such as age, BMI, infertility duration, etc.Conclusions: Dual triggering the final oocyte maturation combined of GnRH-a and standard dose of hCG cannot significantly improve the retrieval, cultural or implantation outcomes of IVF-ET treatments in women with DOR.

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Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols

Cited by 18 publications

References 23 publications

Successful Oocyte Retrieval, Fertilization, and Clinical Pregnancy with Low Serum β-hCG on the Day of Oocyte Collection: A Reappraisal of the Definition of the Empty Follicle Syndrome

Successful Oocyte Retrieval, Fertilization, and Clinical Pregnancy with Low Serum β-hCG on the Day of Oocyte Collection: A Reappraisal of the Definition of the Empty Follicle Syndrome

GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials

A Retrospective Analysis on the Clinical Efficiency of Dual Trigger During Vitro Fertilization and Embryo Transfer (IVF-ET) Treatment for Women with Diminished Ovarian Reserve

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