Dual trigger with gonadotropin-releasing hormone and human chorionic gonadotropin for poor responders

Eser, Ahmet; Devranoğlu, Belgin; Ergen, Evrim Bostancı; Abide, Çiğdem Yayla

doi:10.4274/jtgga.2017.0045

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…However, other studies have found dual-trigger to be ineffective at improving IVF outcomes for this population. Eser et al [24], in a case control study involving 47 dual-trigger and 62 hCG only trigger cases fulfilling the Bologna criteria for POR, discovered no statistical different between the two groups with reference to implantation rate, biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate. Due to the divergence of opinion on the effectiveness and clinical utility of dual-trigger for final oocyte maturation, large scale randomized controlled trials are required to reach a verdict.…”

Section: Discussionmentioning

confidence: 97%

Dual-Trigger Improves the Outcomes of in Vitro Fertilization Cycles in Older Patients with Diminished Ovarian Reserve: a retrospective cohort study

Chern

Tsui

et al. 2020

Preprint

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Background: Dual-trigger for final oocyte maturation has been applied on the women with poor ovarian response or diminished ovarian reserve. However, the results were controversial. The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) stratification is a set of newly established criteria for low prognosis patients. The aim of this study was to examine the effectiveness of dual trigger for final oocyte maturation on the in vitro fertilization (IVF) outcomes of patients who fulfill the POSEIDON group 4 criteria.Methods: This retrospective cohort study investigated 384 cycles fulfilling the POSEIDON group 4 criteria. The patients underwent IVF treatment using the gonadotropin-releasing hormone (GnRH) antagonist protocol. The study group contained 194 cycles that received dual trigger (human chorionic gonadotropin [hCG] plus GnRH agonist) for final oocyte maturation. The control group included 114 cycles where final oocyte maturation was performed with only hCG. Baseline characteristics and cycle parameters, as well as IVF outcomes of both groups were compared.Results: Baseline characteristics were similar between the dual trigger group and the control group. In terms of IVF outcomes, the dual trigger group demonstrated significantly higher number of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day-3 embryos, and top-quality day-3 embryos. A statistically significant improvement in clinical pregnancy rate and live birth rate was also observed in the dual trigger group. Regardless of whether the patients were aged < 40 or ≥ 40 years, those receiving dual trigger had increased numbers of oocytes retrieved, fertilized oocytes, day-3 embryos, top-quality day-3 embryos than those with hCG-only trigger. Clinical pregnancy rate and live birth rate were significantly increased in the < 40-year old group whilst not significantly increased in those ≥ 40 years.Conclusions: Our data suggests that dual trigger for final oocyte maturation might improve clinical pregnancy rates and live birth rates of IVF cycles in patients fulfilling the POSEIDON group 4 criteria.

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Section: Discussionmentioning

confidence: 97%

Dual-Trigger Improves the Outcomes of in Vitro Fertilization Cycles in Older Patients with Diminished Ovarian Reserve: a retrospective cohort study

Chern

Tsui

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…With the extensive application of the GnRH antagonist scheme, GnRH-a has been used as an alternative trigger drug, which can effectively promote the release of endogenous FSH and LH to induce follicle maturation and ovulation, as well as embryo development and pregnancy rates which are similar to those obtained using hCG trigger [7]. Compared with hCG trigger, the duration of the LH surge is shortened, thereby the risk of OHSS was reduced [8]. The incidence of EFS after a GnRH-a trigger has similar rate with hCG trigger [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Low LH level does not indicate poor IVF cycle outcomes with GnRh-a single trigger: a retrospective analysis

Li¹,

Wang

He³

et al. 2022

BMC Pregnancy Childbirth

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Objective To compare the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle outcomes between patients with low and normal serum luteinizing hormone (LH) levels on the day after a gonadotropin-releasing hormone agonist (GnRH-a) single trigger. We further investigated the efficacy of human chorionic gonadotropin (hCG) retrigger on IVF cycle outcomes in patients with low LH levels after GnRH-a single trigger. Methods We retrospectively analyzed 957 infertile patients (tubal factor, ovulation disorders, male sperm factor, or unexplained infertility) who were treated with IVF/ICSI at the Chengdu Xinan Gynecology Hospital from July 2017 to December 2020. Patients received sufficient GnRH-a single trigger were divided into two groups based on the serum LH levels on the next day of trigger: normal serum LH levels (≥ 10 mIU/mL) group (control group, n = 906) and low LH levels (< 10 mIU/mL) group (experimental group, n = 51). And the efficacy of hCG retrigger on IVF/ICSI cycle outcomes in 10 patients with low LH levels after GnRH-a single trigger. Results There were no significant differences in IVF/ICSI cycle outcomes, including egg yield, two pronuclei fertilization rate, excellent embryo rate, or live birth rate of frozen-thawed embryos between patients with low and normal LH levels after GnRH-a trigger. It showed significantly higher risk of ovarian hyperstimulation syndrome in the group of low LH levels [ 0.7%(1/137) vs. 8.5%(4/47), P = 0.016] compared with the group of normal LH levels who received GnRH-a single trigger. The hCG retrigger had no obvious efficacy on cycle outcomes in patients with low LH levels, including oocytes retrieved, fertilization rate, embryo conditions, and live birth rate of frozen-thawed cycles. Conclusion The IVF/ICSI cycle outcomes of patients with low LH levels on the day after GnRH-a administration were similar to those of patients with normal LH levels. Blood LH test might not be required on the day following the trigger. The hCG retrigger did not have any effect on the cycle outcomes, suggesting that immediate retriggering with hCG was unnecessary.

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“…With the extensive application of the antagonist scheme, GnRH-a is often used as a trigger drug, which can promote the release of endogenous FSH and LH to promote follicle maturation and induce ovulation in a short time. Compared with HCG, the duration of the LH surge is shortened, thereby reducing the risk of OHSS [9]. The incidence of EFS after a GnRH-a triggering has been reported to be 3.3% (9/271) [10].…”

Section: Discussionmentioning

confidence: 99%

LH level does not indicate poor response to GnRh-a single trigger: A retrospective analysis

Li¹,

Wang

He³

et al. 2022

Preprint

View full text Add to dashboard Cite

Objective: To compare the embryo condition and clinical outcomes between patients with low and normal serum luteinizing hormone (LH) levels on the day after a single trigger of gonadotropin-releasing hormone agonist (GnRH-a). In patients with low LH levels we further analyzed the efficacy of human chorionic gonadotropin (HCG) to trigger ovulation.Methods: We retrospectively analyzed 957 infertile patients (tubal factor, ovulation disorders, male sperm factor, or unexplained infertility) who were treated with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)-assisted pregnancy at the Chengdu Xinan Gynecology Hospital from July 2017 to December 2020. Patients with sufficient GnRH-a single trigger and normal serum LH levels on the next day were used as the control group (n=906), and patients with low LH levels were set as the experimental group (n=51), of whom 10 received HCG retriggering. We analyzed the effects of low and normal LH levels, and the efficacy HCG retriggering in patients with low LH level on the embryo status and embryonic transplantation after cryopreservation outcome of patients. Results: There were no significant differences in egg yield, 2PN fertilization rate, excellent embryo rate, or live birth rate of frozen-thawed embryos between patients with low and normal LH levels after GnRH-a trigger. There was also no difference in patients with low LH levels who received HCG retriggering or not.Conclusion: The outcomes of patients with low LH levels on the day after GnRH-a administration were similar to those of patients with normal LH levels. The embryo status and live birth rate of frozen-thawed embryos in patients with low LH levels in the HCG retriggering and non-HCG retriggering groups are similar. When blood LH< 10 miu/ml was measured on the day after GnRH-a trigger, no special treatment was required, and there was no significant effect on embryonic and clinical outcomes. No blood LH test is required on the day following the trigger, which does not affect the outcome of in vitro fertilization.

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Dual trigger with gonadotropin-releasing hormone and human chorionic gonadotropin for poor responders

Cited by 16 publications

References 26 publications

Dual-Trigger Improves the Outcomes of in Vitro Fertilization Cycles in Older Patients with Diminished Ovarian Reserve: a retrospective cohort study

Dual-Trigger Improves the Outcomes of in Vitro Fertilization Cycles in Older Patients with Diminished Ovarian Reserve: a retrospective cohort study

Low LH level does not indicate poor IVF cycle outcomes with GnRh-a single trigger: a retrospective analysis

LH level does not indicate poor response to GnRh-a single trigger: A retrospective analysis

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