Abdullah KARAER, Fatih YİĞİT, Görkem TUNCAY

Comparison of the administration of dual and standard trigger in patients undergoing IVF Treatment

Aim: This study aimed to compare in vitro fertilization (IVF) outcomes in patients who were administered dual trigger due to OHSS risk in the GnRH antagonist protocol with patients who were administered standard trigger.Materials and Methods: The medical files were retrospectively scanned for all the patients who were admitted to Inonu Unıversity department of obstetrics and gynecology.While the dual trigger group was composed of patients with OHSS risk who were stimulated with GnRH antagonist and received dual trigger(hCG + GnRHa) for final oocyte maturation, the age-matched (20-40) control group consisted of patients who were administered standard trigger (10000 IU uhCG or 500 μgrrhCG and obtained oocyte counts of 500 μgr recombinant hCG). Thetwo groups were compared in terms of the oocyte count, MII oocyte count, and pregnancy and birth outcomes.Results: There was no statistically significant difference between the two groups in terms of age, weight, height, BMI, duration of marriage, presence of previous pregnancy, number of previous parities, number of pre-existing children, number of previous abortus stories, number of smokers, duration of infertility, LH, E2, prolactin, TSH levels, infertility causes, and hCG dose endometrium thickness. The number of oocytes and MII oocytes obtained was significantly higher in the dual trigger group compared to the control group. There was no statistically significant difference between the two groups in terms of the number of pregnancies and number of deliveries. Conclusion: Although the number of oocytes and MII oocytes was higher in the dual trigger group compared to the control group, there was no significant difference in terms of the pregnancy ratios and the number of deliveries.

PDF

___

1. Gnoth C, Godehardt E, Frank-Herrmann P, et al. Definition and prevalence of subfertility and infertility. Human Reproduction 2005;20:1144-7.
2. Kasum M, Kurdija K, Orešković S, et al.Combined ovulation triggering with GnRH agonist and hCG in IVF patients. Gynecol Endocrinol 2016;32:861-5.
3. T İrez. CTF IVF Laboratory Protocols 2004;25-50
4. Schachter M, Friedler S, Ron-El R, et al. Can pregnancy rate be improved in gonadotropin-releasing hormone (GnRH) antagonist cycles by administering GnRH agonist before oocyte retrieval? A prospective, randomized study. Fertility Sterility 2008;90:1087-93.
5. Decleer W, Osmanagaoglu K, Seynhave B, et al. Comparison of hCG triggering versus hCG in combination with a GnRH agonist: a prospective randomized controlled trial. Facts, Views Vision ObGyn 2014;6:203.
6. Elias RT, Pereira N, Artusa L, et al. Combined GnRHagonist and human chorionic gonadotropin trigger improves ICSI cycle outcomes in patients with history of poor fertilization. J Assisted Reproduction Genetics 2017;34:781-8.
7. Ding N, Liu X, Jian Q, et al. Dual trigger of final oocyte maturation with a combination of GnRH agonist and hCG versus a hCG alone trigger in GnRH antagonist cycle for in vitro fertilization: a systematic review and meta-analysis. Eur J Obstetrics Gynecol Reproductive Biolog 2017;218:92-8.
8. Seval MM, Özmen B, Atabekoğlu C, et al. Dual trigger with gonadotropin releasing hormone agonist and recombinant human chorionic gonadotropin improves in vitro fertilization outcome in gonadotropin releasing hormone antagonist cycles. J Obstetrics Gynaecol Res 2016;42:1146-51.
9. Li S, Zhou D, Yin T, et al. Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols. Oncotarget 2018;9:5337.
10. Ben-Haroush A, Sapir O, Salman L, et al. Does ‘Dual Trigger’Increase Oocyte Maturation Rate?. J Obstetrics Gynaecol 2020;40:860-2.
11. Fanchin R, Peltier E, Frydman R, et al. Human chorionic gonadotropin: does it affect human endometrial morphology in vivo?. In Seminars In Reproductive Medicine 2001;19:31-6.
12. Lin MH, Wu FS Y, Lee RKK, et al. Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles. Fertility and Sterility 2013;100:1296-302.
13. Griffin D, Benadiva C, Kummer N, et al. Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders. Fertility Sterility 2012;97:1316-20.
14. Shapiro BS, Daneshmand ST, Garner FC, et al. Comparison of “triggers” using leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. Fertility Sterility 2011;95:2715-7.
15. Humaidan P. Luteal phase rescue in high-risk OHSS patients by GnRHa triggering in combination with lowdose HCG: a pilot study. Reproductive Biomedicine Online 2009;18:630-4.