A comparison of Dual triggering by administration of GnRH agonist plus HCG versus HCG in normal responders in ART outcomes

Background: The fact that gene expression pattern and downstream signaling of LH receptors is different between hCG and GnRH-a triggered patients made several investigators to study the effect of coadministration of GnRH-a and hCG triggering to improve ART outcomes[10-12] Several studies in high responders showed significant improvement in IVF outcomes when a dual trigger was used without a significant increase in the OHSS rate. Simultaneousadministration of standard dose of hCG and GnRH agonists for triggering the final oocyte maturation has been studied in a limited number of studiesMethods: This double-blind randomized controlled trial was performed at the Research and Clinical Center for Infertility,Shahid Sadoughi University of medical Sciences between April 2014 until February 2015 This study was approved by the ethical committee of the Reasearch and Clinical Center for Infertility,Yazd on 22 June , 2014.(Reference code:315).The study was registered under IRCT2015031221420N2.210 patients began ovarian stimulation with a flexible GnRH antagonist protocol for 5 consecutive days. Once the leading follicle had reached a size of 13 mm, co-treatment with the GnRH antagonist 0.25 mg/day, was initiated. Gonadotropins doses were further adjusted according to vaginal ultrasound measurements of follicular diameter,obtained every two or three days. When at least two leading follicles had reached 17 mm in diameter, final oocyte maturation was triggered by either 6500 I.U. hCG alone, or by 6500 IU hCG plus 0.2 mg of triptorelin (Decapeptyl; Ferring GmbH).Oocyte retrievals were performed under transvaginal ultrasound guidance 34 to 36 hours after triggering. All embryo transfers were performed 48 to72 hours after oocyte retrieval. The luteal phase was supported by daily progesterone suppositories(total dose 800mg) starting on the day of oocyte retrieval.Result: Although mean number of oocytes retrieved and mature metaphase II (MII) oocytes and obtained embryos were higher in the dual-trigger group compared with the controls, the observed differences were short of reaching statistical significance.The differences of OHSS rate between the two groups werenot statistically significant Conclusion: The results of our study did not confirm the favorable effect of dual-triggered oocyte maturation with a GnRH-agonist and a standard dosage of hCG as an effective strategy to optimize pregnancy outcome for normal responders in GnRH-antagonist cycles. We think that this new concept require more study before becoming a universal COH protocol in IVFpractice

کلیدواژه ها:

ART ، GnRH ، HCG