Dual trigger with gonadotropin releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates

Capsule:
We report on how a dual trigger of GnRH-a and hCG improves the percentage of mature oocytes retrieved in patients with a history of low oocyte maturity.

Authors:
Daniel Griffin, M.D., Richard Feinn, Ph.D., Lawrence Engmann, M.D., John Nulsen, M.D., Tara Budinetz, D.O., Claudio Benadiva, M.D.

Volume 102, Issue 2, Pages 405–409

Abstract:

Objective:
To evaluate the percentage (%) of mature oocytes retrieved in patients with a previous history of >25% immature oocytes retrieved who were triggered with gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) to induce oocyte maturation.

Design:
Retrospective cohort study.

Setting:
A university-based tertiary fertility center.

Patient(s):
Patients with a history of >25% immature oocytes retrieved in a prior in vitro fertilization cycle who were triggered with GnRH-a and hCG 5,000 IU or 10,000 IU in a subsequent cycle from January 2008 through February 2012.

Intervention(s):
Dual trigger of GnRH-a and hCG 5,000 or 10,000 IU.

Main Outcome Measure(s):
Percent of mature oocytes retrieved and fertilization rate.

Result(s):
The proportion of mature oocytes retrieved was significantly higher with a dual trigger compared with the subject’s previous cycle (75.0%, interquartile range 55.6%–80.0% vs. 38.5%, interquartile range 16.7%–55.6%). The odds of a mature oocyte retrieved for patients who received a dual trigger was 2.51 times higher after controlling for stimulation protocol, hCG dose, gonadotropin dose, and oocyte retrieval time interval (odds ratio 2.51; confidence interval 1.06–5.96). The implantation, clinical, and ongoing pregnancy rates for the dual trigger were 11.8%, 26.1%, and 17.4%, respectively.

Conclusion(s):
In patients with a low percentage of mature oocytes retrieved who are triggered with a combination of GnRH-a and hCG, the % of mature oocytes retrieved improved. in vitro fertilization outcomes, however, remain poor, suggesting an underlying oocyte dysfunction.

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