The Effect of Dual Trigger of Oocyte Maturation with Gonadotropin-Releasing Hormone Agonist and Low-Dose Human Chorionic Gonadotropin on Pregnancy Rate in Women at Risk of Ovarian Hyperstimulation Syndrome

Abstract

Background: the purpose of this study was to compare rates of ovarian hyperstimulation syndrome (OHSS) and the pregnancy outcome after using gonadotropin-releasing hormone agonists (GnRHa) alone and GnRHa in combination with low-dose human chorionic gonadotropin (hCG, dual trigger) for final oocyte maturation in women undergoing controlled ovarian hyperstimulation (COH). Patients and Methods: the study included 150 female patients with high risk of OHSS occurrence who were allocated by the Computer-based randomization method into two groups with 75 patients in each arm, Group I received GnRHa trigger and Group II received dual trigger (GnRHa + low-dose (1500 IU) hCG trigger). Results: Our study showed that the incidence of OHSS was higher after dual trigger than GnRHa trigger but with no statistically significant difference (8.0 vs 1.33 %, p >0.05). There were 6 cases of OHSS developed with dual trigger group (Group II) (3 were mild early OHSS, 2 were moderate early and one case was severe late OHSS). In contrast, there was only one case of severe late OHSS seen in Group I. Conclusion: Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with increased the incidence of early OHSS compared to GnRH alone. However, dual trigger appears to be a safe approach with a satisfactory pregnancy outcome. Also, the dual trigger improves the oocyte maturation, the number of yield embryos and the quality of embryos.