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

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.

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


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.

Retrospective cohort study.

A university-based tertiary fertility center.

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.

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.

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.

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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