Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders

Daniel Griffin, Claudio Benadiva, Nicole Kummer, Tara Budinetz, John Nulsen, Lawrence Engmann
Fertility and Sterility 2012, 97 (6): 1316-20

OBJECTIVE: To compare live birth rates after dual trigger of oocyte maturation with GnRH agonist (GnRHa) and low-dose hCG versus GnRHa alone in high responders with peak E(2) <4,000 pg/mL at risk of ovarian hyperstimulation syndrome (OHSS).

DESIGN: Retrospective cohort study.

SETTING: University-based tertiary-care fertility center.

PATIENT(S): Patients <40 years old with peak E(2) <4,000 pg/mL at risk of OHSS who underwent IVF/intracytoplasmic sperm injection with GnRH antagonist protocol and triggered with GnRHa alone or GnRHa plus 1,000 IU hCG (dual trigger) for oocyte maturation.

INTERVENTION(S): GnRHa alone versus dual trigger.

MAIN OUTCOME MEASURE(S): Live birth, implantation, and clinical pregnancy rates and OHSS.

RESULT(S): The dual-trigger group had a significantly higher live birth rate (52.9% vs. 30.9%), implantation rate (41.9% vs. 22.1%), and clinical pregnancy rate (58.8% vs. 36.8%) compared with the GnRHa trigger group. One case of mild OHSS occurred in the dual-trigger group, and there were no cases of OHSS in the GnRHa trigger group.

CONCLUSION(S): Dual trigger of oocyte maturation with GnRHa and low-dose hCG in high responders with peak E(2) <4,000 pg/mL improves the probability of conception and live birth without increasing the risk of significant OHSS.

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