Dual trigger with combination of gonadotropin releasing hormone agonist and human chorionic gondadotropin significantly improves live birth rate for normal responders in GnRH antagonist cycles

Capsule:
Dual trigger with gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin improves implantation, clinical pregnancy, and live-birth rates for normal responders in GnRH-antagonist IVF-ICSI cycles.

Authors:
Ming-Hui Lin, M.D., Frank Shao-Ying Wu, M.D., Robert Kuo-Kuang Lee, M.D., Sheng-Hsiang Li, Ph.D., Shyr-Yeu Lin, M.D., Yuh-Ming Hwu, M.D.

Volume 100, Issue 5, Pages 1296-1302, November 2013

Abstract:

Objective:
To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the live-birth rate for normal responders in GnRH-antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles.

Design:
Retrospective cohort study.

Setting:
Infertility unit of a university-affiliated medical center.

Patient(s):
Normal responders to controlled ovarian hyperstimulation who were undergoing IVF-ICSI with a GnRH antagonist protocol.

Intervention(s):
Standard dosage of hCG trigger (6,500 IU of recombinant hCG) versus dual trigger (0.2 mg of triptorelin and 6,500 IU of recombinant hCG).

Main Outcome Measure(s):
Live-birth, clinical pregnancy, and implantation rates per cycle.

Result(s):
A total of 376 patients with 378 completed cycles with embryo transfer were enrolled (hCG trigger/control group: n = 187; dual trigger/study group: n = 191). The dual trigger group demonstrated statistically significantly higher implantation (29.6% vs. 18.4%), clinical pregnancy (50.7% vs. 40.1%), and live-birth (41.3% vs. 30.4%) rates as compared with the hCG trigger group. There was no statistically significant difference in terms of patient demographics, cycle parameters, or embryo quality.

Conclusion(s):
Dual trigger of final oocyte maturation with a GnRH-agonist and a standard dosage of hCG in normal responders statistically significantly improves implantation, clinical pregnancy, and live-birth rates in GnRH-antagonist IVF cycles.

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