Dual Trigger with Gonadotropin-releasing Hormone Agonist and Human Chorionic Gonadotropin Improves Live Birth Rate for Women with Expected Normal Ovarian Response in Gonadotropin Releasing Hormone Antagonist Cycles: Retrospective Study

Abstract

Objective: To evaluate and compare cycle outcomes following triggering final oocyte maturation with dual trigger of concomitant gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) administration versus hCG alone for women with expected normal ovarian response that underwent antagonist cycles with intracytoplasmic sperm injection (ICSI). Material and Methods: Women with expected normal ovarian response that underwent GnRH antagonist cycles with ICSI between January 2010 and April 2020 were evaluated in this retrospective cohort study. A total of 2,443 patients were included. Dual trigger was used for oocyte maturation in 637 cycles whereas hCG alone was used for triggering in 1,806 women. Cycles with dual trigger were assigned to study group and cycles with hCG alone are taken as controls. Results: Number of retrieved oocytes (14.08±3.58 vs. 13.15±3.61), number of metaphase 2 oocytes (9.77±3.08 vs. 8.06±3.14), fertilization rate (0.75±0.19 vs. 0.69±0.19), implantation rate (0.43±0.48 vs. 0.35±0.50) and clinical pregnancy rate (49.9% vs. 40.6%) were significantly higher in dual trigger group in comparison to hCG alone group. Higher number of good quality embryos were obtained in dual trigger group (85.7% vs. 76.3%). Live birth rate was significantly increased in dual trigger group in comparison to hCG only trigger group (45.1% vs. 36.7%). Multivariate logistic regression analysis showed dual trigger is a significant factor in predicting live birth deliveries (odds ratio 1.426, 95% confidence interval 1.185-1.716). Conclusion: Dual-triggering appears to improve embryo quality, increase implantation rates, clinical pregnancy rates and live birth rates in women with expected normal ovarian response that underwent GnRH antagonist cycles.