Dual triggering for final oocyte maturation compared to single triggering in GnRH antagonist (IVF-ICSI) protocols

Document Type : Original Article

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1 Obstetrics and gynecology faculty of medicine Ain shams university

2 Obstetrics and gynecology faculty of medicine Ain shams university Cairo Egypt

Abstract

Objective: To investigate whether co-administration of GnRH-a and hCG for final oocyte maturation (dual trigger) would improve number of oocytes retrieved& its quality and eventually IVF/ICSI clinical outcomes compared to single triggers in women with normal ovarian response undergoing (IVF/ICSI) technique using GnRH antagonist protocol of stimulation.
Design: A Retrospective Cohort Study.
Setting: Ain Shams University, maternity hospital, assisted reproductive technology unit (ART unit).
Materials and Methods: A review of medical records of a total 120 patients aged between 20-38 years old, with normal ovarian response who underwent IVF/ICSI using GnRH antagonist protocol of controlled ovarian hyper-stimulation. Patients were grouped into 2 groups, by whether final oocyte maturation was triggered with GnRH agonist plus standard dose of hCG (Group A, dual trigger/study group: n= 60) or hCG alone (Group B, hCG trigger/control group: n= 60).
Main Outcome Variable(s): The main study outcome variable was the Implantation rate. Other analyzed variables included the oocyte number and stage of maturity, the fertilization rate, the clinical pregnancy rate, the incidence of severs OHSS, and embryo transfer cancellation rate.
Results: Our study showed statistically significant difference with p-value <0.05 between study groups as regards to the number of retrieved oocytes (cases: 10.73±2.94 vs. control: 9.33±3.6), number of MII oocyte retrieved (dual trigger: 6.2±2.7 vs. single trigger: 4.6±3.1), and number of fertilized oocyte (dual trigger: 4.03±2.2 vs. single trigger: 3.05±2.5) with higher mean among dual trigger group. In the current study also the dual-trigger group demonstrated a significantly higher percentage as regards to biochemical pregnancy rate (cases: 68.3%vs. 33.3% among controls), implantation rate (cases: 41.3% vs. 21.4% among controls), and clinical pregnancy rate (cases: 58.3% vs. 31.7% among controls) with a statistically significant difference with p-value <0.05 between study groups. Both groups showed no statistically significant difference as regards to the mean number of transferred embryos (1.9±1.01 in cases vs. 1.7±1.2 in control) and number of frozen embryos (1.33±1.08 in cases vs. 1.1±1.4 in control), or as regards to complications; whether ET cancellation or incidence of sever OHSS.
Conclusion: In conclusion, in terms of the number of mature retrieved oocytes, implantation rate and clinical pregnancy rate in normal responders undergoing IVF/ICSI using antagonist protocols, a dual-trigger approach with a GnRH agonist and the standard dosage of hCG was found to be significantly superior to an hCG trigger alone.

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