Evaluation of dual trigger with gonadotropin-releasing hormone agonist and human chorionic gonadotropin in improving oocyte maturity rates: A prospective randomized study

Abstract

BACKGROUND:Mature oocytes are prerequisite for achieving the process of in vitro fertilization. Human chorionic gonadotropin (hCG) is the standard trigger used for stimulating ovulation but is associated with ovarian hyperstimulation syndrome (OHSS). Gonadotropin-releasing hormone agonist trigger achieves oocyte maturation and lowers the incidence of OHSS, but it has limitations of higher pregnancy loss rate and miscarriage rates. Coadministration of both hormones is found to improve the pregnancy rates and the number of mature oocytes retrieved. We aimed to assess if the dual trigger is better than the conventional hCG in triggering oocyte maturation.METHODOLOGY:The study included 76 female patients aged 24–43 years who were randomly divided into two groups with 38 patients in each arm. The study included patients with antimullerian hormone (AMH) <4 ng/ml, antral follicle counts (AFCs)/ovary <12. The study excluded high responders-AMH >4 ng/ml and AFC/ovary >12 to avoid OHSS risk with hCG trigger.RESULTS:The study showed statistically insignificant differences between dual group versus hCG group in terms of the number of oocytes retrieved (10.0 ± 5.6 vs. 8.7 ± 5.0; P = 0.2816), the number of mature oocytes recovered (8.4 ± 5.0 vs. 7.2 ± 4.0; P = 0.2588), fertilization rate (5.9 ± 4.2 vs. 5.6 ± 3.3; P = 0.7390), and the number of usable embryos on day 3 (4.0 ± 3.0 vs. 4.0 ± 2.4; P = 0.8991).CONCLUSION:The dual trigger is equivalent to hCG in triggering oocyte maturation.

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

“…Ding et al ( 179 ) conducted a meta-analysis including 527 women from four eligible RCTs to investigate the efficacy of the dual trigger in comparison with hCG alone [Schachter et al ( 177 ) in 2008, Decleer et al ( 178 ) in 2014, Kim et al ( 180 ) in 2014, Mahajan et al ( 181 ) in 2016]. The analysis did not demonstrate any difference in the number of oocytes, mature oocytes, zygotes, or implantation rate, although it did find an increase in the pregnancy rate in the GnRHa-supplemented group as compared with hCG alone (relative risk, 1.55; 95% CI, 1.17 to 2.06) ( 179 ).…”

GnRH agonist in association with hCG versus hCG alone for final oocyte maturation triggering in GnRH antagonist cycles

“…A non-significantly higher number of MII oocytes was retrieved with the dual trigger strategy, when compared with hCG alone. This finding is in agreement with previous prospective randomized controlled trials (RCTs), which also demonstrated that although the number of mature oocytes retrieved was higher with the dual trigger strategy than hCG alone, the difference did not reach statistical significance ( Decleer et al ., 2014 ; Kim et al ., 2014 ; Mahajan et al ., 2016 ). The same was also shown for the number of total oocytes retrieved ( Schachter et al ., 2008 ; Mahajan et al ., 2016 ).…”

“…This finding is in agreement with previous prospective randomized controlled trials (RCTs), which also demonstrated that although the number of mature oocytes retrieved was higher with the dual trigger strategy than hCG alone, the difference did not reach statistical significance ( Decleer et al ., 2014 ; Kim et al ., 2014 ; Mahajan et al ., 2016 ). The same was also shown for the number of total oocytes retrieved ( Schachter et al ., 2008 ; Mahajan et al ., 2016 ). When the data from these 4 RCTs were pooled together in two recent systematic reviews, the lack of significance between the groups in relation to the number of total and MII oocytes retrieved was confirmed ( Ding et al ., 2017 ; Chen et al ., 2018 ).…”

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

“…48 Role and application of dual trigger were further explored in various studies. Ding et al conducted a meta-analysis including 527 women from four eligible RCTs to investigate the efficacy of the dual trigger in comparison to hCG alone (Schachter et al 49 in 2008, Decleer et al 50 in 2014, Kim et al 51 in 2014, Mahajan et al 52 in 2016). The analysis did not demonstrate any difference in the number of oocytes, mature oocytes, zygotes, or implantation rate, although it did find an increase in the pregnancy rate in the GnRHa-supplemented group when compared to hCG alone (relative risk, 1.55; 95% CI, 1.17-2.06).…”