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

Abstract

Objective: To analyze gonadotropin-releasing hormone (GnRH) agonist in association with human chorionic gonadotropin (hCG) (dual triggering) versus hCG alone (conventional triggering) for final oocyte maturation triggering in GnRH antagonist cycles in an unselected population of Brazilian women. Methods: This prospective case-control study involved 114 patients referred to autologous in vitro fertilization treatment between February 2018 and August 2019, recruited regardless of age, infertility factor or number of cycles. The patients were randomly allocated into two groups according to oocyte maturation triggering approach: group A (n = 48) - hCG only; and group B (n = 66) - hCG plus GnRH agonist. The main outcomes measured were the number of total and metaphase II (MII) oocytes retrieved. Results: The groups were homogenous in terms of age. There were no moderate or severe ovarian hyperstimulation syndrome events. There were no statistical differences concerning total or MII oocytes retrieved between the groups ( p > 0.05). The MII/total oocyte rate was 70.9% in group A, and 74.5% in group B ( p = 0.679). There was no oocyte retrieved in 2/48 patients (4.16%) in group A, 1/66 (1.5%) in group B. There were no MII oocytes in 4/48 patients (8.3%) in group A, and 2/66 (3%) in group B. Age was directly correlated to the number of total and MII oocytes retrieved ( p < 0.05). Conclusions: Dual triggering was equivalent to conventional hCH triggering in terms of the number of total and MII oocytes retrieved in the general population. Further studies are necessary to ascertain dual triggering indication in selected groups of women.

Dual trigger and the impact on oocyte quality and embryo development: a Brazilian cohort

“…Their study also showed that the fertilization rate was similar between dual trigger and hCG protocol (mean±SD: 58±24 and 53±35, respectively; p =0.120) ( Ben-Haroush et al ., 2020 ). Similar results were shown recently by Oliveira et al . (2021 ).…”

“…Many studies proved its efficacy in inducing oocyte maturation ( Haas et al ., 2016 ; Oliveira et al ., 2016 ; Elias et al ., 2017 ; Zhang et al ., 2017 ; Ali et al ., 2020 ; Ben-Haroush et al ., 2020 ; Kim et al ., 2020 ), number of retrieved oocytes ( Haas et al ., 2016 ; Oliveira et al ., 2016 ; Fabris et al ., 2017 ; Zhang et al ., 2017 ), fertilized oocytes ( Oliveira et al ., 2016 ; Elias et al ., 2017 ; Lin et al ., 2019 ; Albeitawi et al ., 2022 ), implantation rate ( Oliveira et al ., 2016 ), clinical pregnancy rates ( Elias et al ., 2017 ; Fabris et al ., 2017 ; Lin et al ., 2019 ; Chern et al ., 2020 ) and live birth rates ( Oliveira et al ., 2016 ; Elias et al ., 2017 ; Lin et al ., 2019 ; Chern et al ., 2020 ; Hu et al ., 2021 ). On the other hand, several studies have shown that dual trigger of oocyte final maturation did not improve or it was equivalent to conventional hCG triggering in terms of IVF outcome ( Ding et al ., 2017 ; Eser et al ., 2018 ; Oliveira et al ., 2021 ). Since there is conflicting evidence regarding de benefits of dual triggering protocol in human reproduction assisted techniques, we aimed to contribute with new data about the subject.…”

“…Although the dual trigger protocol was superior in terms of increasing the total number of oocytes retrieved and the number of oocytes inseminated compared to the hCG protocol, the results of the present study showed that regarding to the number of follicles, the number of MII oocytes recovered, number of fertilized oocytes and number of IVM, both protocols were equivalent. Similar results were also found by other authors ( Ding et al ., 2017 ; Eser et al , 2018 ; Ben-Haroush et al , 2020 ; Oliveira et al ., 2021 ; Shapiro et al ., 2021 ; Dong et al ., 2022 ; Zhou et al ., 2022 ).…”

Dual-trigger improves oocyte maturation in patients with low oocyte maturation rate: a self-control study

“…In clinical practice, some investigations have shown the bene ts of using a dual-trigger for nal oocyte maturation and better clinical outcomes [12][13][14], while others have reported comparable or even worse outcomes [15,37]. Lately, a well-designed RCT study by Haas et al reported a promising effect of dual trigger in normal responders [13].…”

“…Since then, several trials have studied the use of dual-trigger and demonstrated lower risk of OHSS and similar or better clinical outcomes compared to the hCG-only trigger [11][12][13][14]. In the general population, some studies suggested that the dual-trigger improved the oocyte maturation rate [13,14], while others denied this positive effect [15]. Haas et al performed a large RCT and the results showed that, for normal responders, the dual trigger increased the number of oocytes, mature oocytes and number of blastocysts compared to the hCG-only trigger [13].…”