Comparison of GnRH Agonist, hCG, and Dual Trigger for Final Oocyte Maturation in IVF Cycle

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Objectives: This study aims to analyze the effects of three types of triggers— human chorionic gonadotropin (hCG), GnRH-a, or a combination of them (dual)—on the quality of oocytes, embryos, and ovarian hyper-stimulation syndrome (OHSS) in the ICSI cycle. Materials and Methods: A prospective case-control study was conducted on 320 women referred to Milad IVF Center, Mashhad, Iran, between May 2016 and June 2019. All the participants underwent an antagonist protocol and were classified according to the trigger type into three groups: 118 patients in the GnRH-a group, 49 in the hCG group, and 153 in a dual group. The outcome measures included the number of metaphase I and metaphase II oocytes, germinal vesicle (GV) oocytes, high-quality embryos, and the rate of OHSS. Results: The three groups did not exhibit statistically significant differences concerning the quantities of retrieved oocytes: M II oocytes, M I oocytes, GV oocytes, and embryos. The dual trigger method resulted in significantly higher embryo quality (P=0.017). In comparison to dual and GnRH-a group triggers, it was observed that women administered with the hCG group trigger displayed an increased occurrence of OHSS, and the number of severe OHSS in the dual trigger was higher than in the GnRH-a and hCG groups. Conclusions: The GnRH agonist alone and the dual trigger can be as effective as the hCG trigger. A GnRH agonist is preferable in high-risk patients. Therefore, it is imperative to administer the treatment based on the patient’s status.