Abstract
Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). However, GnRH agonist has been replacing the use of hCG in certain situations, especially in patients at risk of Ovarian Hyperstimulation Syndrome (OHSS). Some studies have also shown advantages in the combined use of GnRH agonist concurrently with hCG in inducing final oocyte maturation, a treatment known as "Dual Trigger". In theory, this method combines the advantages of both induction regimens, and it has brought promising results. The objective of this study is to compare Dual Trigger with the use of hCG alone or the use of GnRH agonist alone. A systematic review of articles on Dual Trigger and a retrospective cohort study comparing the three methods of induction of final oocyte maturation have been conducted. It has been found that Dual Triggering for poor responder patients had a statistically significant increase in the number of retrieved oocytes, mature oocytes, and fertilized embryos in the positive beta hCG rate, implantation rate, and newborn/transferred embryo (TE) rate.
Highlights
Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) (Decleer et al, 2014)
Systematic Review Five articles comparing the use of GnRH agonist alone with Dual Trigger in high responder patients were found: four retrospective cohort study papers and one prospective study
This article shows that the use of GnRH agonist combined with hCG in inducing final oocyte maturation is an excellent alternative after ovarian stimulation with recombinant FSH and LH, and suppression of premature LH surge with GnRH antagonist, especially in normal responder patients, poor responder patients, or patients with immature oocytes
Summary
Final oocyte maturation with hCG and ovarian stimulation with FSH combined with GnRH antagonist to block LH surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) (Decleer et al, 2014). The use of hCG can result in Ovarian Hyperstimulation Syndrome (OHSS) (Shapiro et al, 2008). This risk is significantly reduced by replacing hCG with a GnRH agonist (Shapiro et al, 2008; Zilberberg et al, 2015; Lin et al, 2013). Once the GnRH agonist — that has a much higher affinity to receptor than the GnRH antagonist — is administered, a displacement of the antagonist from the receptor occurs in the endometrium, and it unlocks these receptors, improving endometrial receptivity (Schachter et al, 2008)
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