A comparison of hCG trigger versus dual trigger for final oocyte maturation in poor ovarian responders

Duong Hoang Long, Ho Sy Hung

Main Article Content

Abstract

This study compared the final oocyte maturation and the embryo formation between two groups,
one group in which follicular maturation was triggered by hCG alone versus the other group
triggered by a combination of hCG and GnRHa. This study was conducted at National Hospital of
Obstetric and Gynaecology. Patients who were poor ovarian responders as defined by the Bologna
criteria were randomized into two groups: the control group received the hCG trigger (10000IU)
and the investigation group received the dual trigger (0.2mg of Triptoreline plus 6500IU of hCG).
The number of retrieved oocytes, number of mature oocytes (MII), number of embryos formation
were all significantly higher in the investigation group compared to control group (p < 0.05). The
fertilization rate and the number of top embryos were not significantly different between the two
groups. Dual trigger for final oocyte maturation can improve IVF outcome in poor ovarian responders.

Article Details

References

1. Humaidan P, Bredkjaer HE, Bungum L, et al. GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study. Hum Reprod Oxf Engl. 2005;20(5):1213-1220. doi: 10.1093/humrep/deh765.
2. Lin MH, Wu FSY, Lee RKK, Li SH, Lin SY, Hwu YM. 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. Fertil Steril. 2013;100(5):1296-1302. doi: 10.1016/j.fertnstert.2013.07.1976.
3. 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. Fertil Steril. 2008;90(4):1087-1093. doi: 10.1016/j.fertnstert.2007.07.1316.
4. Griffin D, Feinn R, Engmann L, Nulsen J, Budinetz T, Benadiva C. Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates. Fertil Steril. 2014;102(2):405-409. doi: 10.1016/j.fertnstert.2 014.04.028.
5. Haas J, Zilberberg E, Dar S, Kedem A, Machtinger R, Orvieto R. Co-administration of GnRH-agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles--a preliminary report. J Ovarian Res. 2014;7:77. doi: 10.1186/1757-2215-7-77.
6. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol. 1997;104(5):521-527. doi: 10.1111/j.1471-0528.1997.tb11525.x.
7. Gonen Y, Balakier H, Powell W, et al. Use of Gonadotropin-Releasing Hormone Agonist to Trigger Follicular Maturation for in Vitro Fertilization. J ClinEndocrinolMetab. 1990;71:918-922.
8. Eftekhar M, Naghshineh E, Neghab N, Hosseinisadat R. A comparison of dual triggering (by administration of GnRH agonist plus HCG) versus HCG alone in poor ovarian responders in ART outcomes. Middle East Fertil Soc J. 2018;23(4):350-353. doi: 10.1016/j.mefs. 2018.04.011.
9. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod Oxf Engl. 2011;26(6):1270-1283. doi: 10.1093/humrep/de r037.
10. Zeleznik AJ, Midgley AR, Reichert LE. Granulosa Cell Maturation in the Rat: Increased Binding of Human Chorionic Gonadotropin Following Treatment with Follicle-Stimulating Hormone in Vivo1. Endocrinology. 1974;95(3):818-825. doi: 10.1210/endo-95-3-8 18.
11. Lamb JD, Shen S, McCulloch C, Jalalian L, Cedars MI, Rosen MP. Follicle-stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in in vitro fertilization cycles: a randomized, double-blind, placebo-controlled trial. Fertil Steril. 2011;95(5):1655-1660. doi: 10.1016/j.fert nstert.2011.01.019.
12. Haas J, Zilberberg E, Nahum R, et al. Does double trigger (GnRH-agonist + hCG) improve outcome in poor responders undergoing IVF-ET cycle? A pilot study. Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol. 2019;35(7):628-630. doi: 10.1080/09513590.2019.1576621.
13. Zhang J, Wang Y, Mao X, et al. Dual trigger of final oocyte maturation in poor ovarian responders undergoing IVF/ICSI cycles. Reprod Biomed Online. 2017;35(6):701-707. doi: 10.1016/j.rbmo.2017.09.002.