Dual Trigger Protocol Before IVF Increases Number of Mature Oocytes Compared With hCG Alone: Presented at ESHRE

By Chris Berrie

BARCELONA, Spain -- July 9, 2018 -- Co-administration of human chorionic gonadotropin (hCG) with gonadotropin-releasing hormone (GnRH) agonist significantly increases numbers of oocytes, mature oocytes, and quality blastocysts compared with hCG alone for women undergoing in vitro fertilization (IVF), according to a study presented here at the 34th Annual Meeting of the European Society for Human Reproduction and Embryology (ESHRE).

During standard IVF stimulation, the luteinising hormone surge of the natural cycle is replaced through use of hCG at the end of controlled ovarian hyperstimulation, to induce final oocyte maturation.

However, in regards to follicle-stimulating hormone (FSH), there is nothing added to “mimic the FSH surge, and we still have great results,” explained Jigal Haas, MD, IVF Unit, TRIO Fertility Clinic, Toronto, Ontario. “So, what are the roles of the FSH surge, and is it really so important?”

Recently, there have been a few retrospective studies on co-administration of GnRH agonist and hCG for final oocyte maturation (dual trigger) in patients with low oocyte recovery rate and low maturation rate. These studies suggested improved IVF outcomes and pregnancy rates.

For the current study, women without previous IVF failures were randomised to a GnRH antagonist cycle triggered with hCG (Pregnyl 10,000 IU) without (n = 80) and with (n = 80) GnRH agonist (Suprefact 0.5 mg) at 36 hours prior to oocyte aspiration.

For the primary endpoint of number of MII oocytes retrieved, significant benefit over hCG alone was seen for the dual trigger (10.1 vs 8.6; P = .04).

Further significant benefits were seen for the dual trigger for a range of associated outcomes, including number of oocytes (12.9 vs 10.6; P = .02), oocytes per number of follicles >10 mm (96.1% vs 76.6%; P = .001), number of zygotes (7.9 vs 6.3; P = .04), cleavage stage embryos (6.6 vs 5.7; P = .03), blastocysts (3.7 vs 3.1; P = .02), and top quality blastocysts (2.5 vs 1.8).

“Using the dual trigger increases the number of oocytes, mature oocytes and number of blastocysts compared with triggering with hCG alone.” Said Dr. Haas. “The increase in the number of mature oocytes may potentially improve the outcome of the IVF cycle.”

[Presentation title: Dual Trigger vs hCG for Final Oocyte Maturation. A Prospective Randomized Controlled, Double Blinded Study. Abstract O-208]

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