The administration of GnRH and HCG: double trigger vs HCG alone for follicular oocyte maturation in poor IVF responders—a randomized controlled trial

Abstract

BackgroundIn vitro fertilization (IVF) has revolutionized human reproduction. Originally designed to assist couples who are unable to conceive, the clinical applications of IVF have significantly broadened to encompass many medical and genetic disorders, as well as fertility maintenance. The poor ovarian response is a very challenging issue in the field of infertility, “double triggering” combines a single bolus of gonadotropic releasing hormone (GnRH)-agonist with a standard dosage of human chorionic gonadotropin (HCG) at the time of triggering has been proposed that it improves the outcomes in poor responders.MethodsTo study this effect, 73 POR patients received 10,000 units of HCG plus 0.2 mg of GnRH-agonist for ovulation triggering (study group) after induction of ovulation using antagonist protocol, while other 73 POR patients received standard dosage of HCG trigger (10,000 units of HCG) (control group) after the same IOO settings.ResultsOur results showed that the study group had a higher number of retrieved Metaphase II oocytes, fertilized oocytes, and number of embryos obtained, than the control group. This difference was statistically significant (P-value < 0.05). Other outcomes like chemical and clinical pregnancy rates were also higher in the study group than in the control group, but this difference was not statistically significant (P-value 0.322 and 0.355, respectively).ConclusionThese findings demonstrated that the use of a double trigger with GnRH agonist and HCG, compared to HCG alone, leads to improved outcomes in poor responder IVF patients. Subsequently, the double-trigger protocol may be a beneficial approach for optimizing outcomes in IVF patients with POR.