DOES DUAL TRIGGER WITH COMBINATION OF GONADOTROPIN-RELEASING HORMONE AGONIST AND LOW DOSE HUMAN CHORIONIC GONADOTROPIN IMPROVES CLINICAL OUTCOMES IN NORMAL RESPONDERS IN GnRH ANTAGONIST IVF-ICSI CYCLES

Abstract

Clinical outcomes of dual trigger containing gonadotropin-releasing hormone agonist (GnRHa) and low dose human chorionic gonadotropin (hCG) compared with the standard dose of human chorionic gonadotropin (hCG) trigger for final oocyte maturation in normal responder patients in GnRH Antagonist IVF-ICSI Cycles. A single centre prospective randomized comparative study conducted at a tertiary care infertility centre , Akanksha IVF centre, Janakpuri, New Delhi from 1st March 2020 to 28th February 2021. 80 normal responder patients defined as women in age group 21 to 37 year, with serum AMH level >1.2 ng/ml to < 4ng/ml , with AFC (3- 8) per ovary who were to undergo controlled ovarian hyperstimulation (COH) for IVF-ICSI cycles, were randomized by a computer based program into 2 groups of 40 each. All the patients underwent ovarian stimulation with a starting dose of recombinant FSH with dosage 150-225 IU on D2 and the dosage were adjusted according to follicular monitoring After at least one follicle reached a size of 14mm , antagonist Inj Cetrorelix 0.25 mg started subcutaneously daily. When > 2 follicles reached the size of 18 mm final oocyte maturation was triggered by either dual trigger of Inj Leuprolide acetate 2 mg and low dose 2000 IU highly purified Inj. hCG subcutaneously in Group 1 or by standard trigger dose 10000 IU of highly purified inj hCG in Group2. Oocyte retrievals were performed 35 to 36 hours after the trigger. IVF-ICSI was performed in all cases. Day 3 fresh embryo transfers were performed for all cases (2 x 8cell embryos).The luteal phase support was with vaginal supplementation of 800 mg micronized progesterone. Serum beta hCG was performed after14 days of embryo transfer . Primary outcome measured was clinical pregnancy rate and secondary outcomes measured were: implantation rate, miscarriage rate, number of MII oocytes picked up, number of embryos formed, and risk of OHSS. In dual trigger , group 1 the clinical pregnancy rate (52.50% vs 47.50% ) and implantation rate (29.67% vs 26.08% ) were higher than in Group 2 , and but the difference was not statistically significant. Miscarriage rate was lesser in group 1 (14.28%) than in group 2 (15.78%) and it was also not statistically significant . There were higher number of MII oocytes picked up and higher number of embryos formed in group1/ dual trigger group (10.63+5.46 and 8.2+3.4 respectively ) than in group 2 (8.10+5.74 and 6.8+3.6 respectively) and this difference was statistically significant . No OHSS was reported in group 1/ dual trigger group. Though there was increased clinical pregnancy rate, implantation rate and a lesser miscarriage rate in dual trigger group1 for but it was statistically not significant .There was significant increase in MII oocytes and number of embryos formed (p value .0064 and .0 156 respectively) in the dual trigger group. There was also no risk of OHSS in dual trigger group.