GnRH-Agonist Trigger versus Human Chorionic Gonadotrophin (HCG) Trigger in Cases of Controlled Ovarian Stimulation;Randomized Controlled Trial

Objectives: The aim of the study was to compare the efficacy and safety of GnRH-agonist to the human chorionic gonadotrophin (HCG) trigger in cases of simple ovarian stimulation. Study design: Randomized controlled trial was conducted on 291 women complaining of unexplained infertility visiting Elshatby Maternity University Hospital from February to December 2019. Trial registration unique ID is PACTR202001787868341 (https://www.pactr.org/). Age included from 20 - 43 years. All patients were stimulated by the sequential stimulation protocol using letrozole then FSH injection, when the criteria of ovulation trigger were reached; cases were randomized into two groups using closed envelopes method. Group A (123 cases) GnRh agonist (triptorelin 0.2 IU) subcutaneous injection and Group B (168 cases) HCG 10,000 IU intramuscular injection were used for triggering of ovulation then followed by timed intercourse. Results: Primary outcome was the clinical pregnancy rate while rate of miscarriage and ovarian hyper-stimulation rate were the secondary outcome. Clinical pregnancy rates, in Group A were (21.1%) while it was (31.5%) in another group (P = 0.049). Miscarriage rate was (4.9%) in the first group and (3.6%) in the second group (P = 0.580). Except for one case of moderate ovarian hyper-stimulation syndrome (OHSS) complicated the HCG group, there were no such cases in GnRH group. Conclusion: Triggering final oocyte maturation with HCG was superior to GnRH agonists triggers as regards the clinical pregnancy rate.