Reproductive outcomes of dual trigger with combination GnRH agonist and hCG versus trigger with hCG alone in women undergoing IVF/ICSI cycles: a retrospective cohort study with propensity score matching

Abstract

Background Despite a large number of studies on the selection of trigger drugs, it remains unclear whether the dual trigger with human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (GnRH) agonist, compared to the trigger with hCG alone, can improve the reproductive outcome of patients undergoing assisted reproductive technology. Therefore, this study aimed to compare the laboratory and clinical outcomes of dual trigger versus single trigger. Methods In this retrospective cohort study, we evaluated 520 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles between July 2014 and September 2020 at the Reproductive and Genetic Center of Integrative Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine. All patients underwent IVF/ICSI treatment with fresh embryo transfer using the GnRH antagonist protocol. We used propensity score matching to control for confounding variables and binary logistic regression analysis to determine the correlations between trigger methods and pregnancy outcomes. After propensity score matching, 57 cycles from each group were evaluated and compared for laboratory or clinical outcomes in this retrospective cohort study. Results There was no significant difference in the number of oocytes retrieved, embryos available, top-quality embryos, or the rate of normal fertilization between the dual-trigger and single-trigger protocols, respectively. The incidence of ovarian hyperstimulation syndrome, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, ectopic pregnancy rate, early miscarriage rate, and live birth rate were also similar between the two groups, while the miscarriage rate (37.0% vs. 12.5%, p = 0.045) was higher in the dual-trigger than the single-trigger group. Subsequent binary logistic regression analysis showed that age was a remarkably significant independent predictor of both clinical pregnancy rate (odds ratio = 0.90, 95% confidence interval: 0.84–0.97, p = 0.006) and live birth rate (odds ratio = 0.89, 95% confidence interval: 0.82–0.97, p = 0.005). Conclusions Therefore, dual-trigger for final oocyte maturation might increase miscarriage rate, but in terms of the laboratory and other pregnancy outcomes such as clinical pregnancy rate, early miscarriage rate or live birth rate, there was no evidence to show that dual trigger was superior to an hCG-trigger alone for patients undergoing GnRH-antagonist cycles with fresh embryo transfer. Trial registration Retrospectively registered.

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

“…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 ).…”

“…Recent studies confirmed the similarity between both protocols for triggering final oocyte maturation. Dong et al . (2022 ) investigated retrospectively whether a dual trigger for final oocyte maturation with a combination of a single dose of GnRH agonist and a standard dose of hCG could improve the reproductive outcomes compared with conventional hCG trigger alone.…”

Establishment and validation of a nomogram for subsequent first-cycle live births in patients diagnosed with recurrent implantation failure: a population-based analysis

“…Normal fertilization was confirmed when the presence of two pronuclei and the extrusion of the second polar body were observed 16–18 h after IVF/ICSI ( 9 , 10 ).…”

Development and validation of a live birth prediction model for expected poor ovarian response patients during IVF/ICSI

“…Normal fertilization was confirmed when the presence of two pronuclei (2PN) and the extrusion of the second polar body(2PB) were observed 16–18 h after IVF/ICSI ( 14 , 15 ). Cleavage embryos were classified as high-quality embryos (grade I and II embryos) if they had seven to nine cells on day 3 and as same-sized blastomeres if with less than 20% blastomeric fragments.…”