Effect of Dual Trigger In Vitro Fertilization and Intracytoplasmic Sperm Injection During the Gonadotropin-releasing Hormone-Antagonist Cycle on Final Oocyte Maturation and Cumulative Live Birth Rate in Women with Diminished Ovarian Reserve

Objective It is well known that a dual trigger treatment can improve clinical outcomes of in vitro fertilization(IVF)in high or normal ovarian responders.However,it is not clear whether dual triggering also benefits patients with diminished ovarian reserve(DOR).The aim of this study was to investigate whether a dual trigger treatment of gonadotropin-releasing hormone(GnRH)agonist combined with human chorionic gonadotropin(hCG)for final follicular maturation improves the cumulative live birth rate(CLBR)during the GnRH-antagonist cycle in patients with DOR.Methods This retrospective study included patients with DOR who received a GnRH-antagonist protocol during IVF and intracytoplasmic sperm injection(IVF-ICSI)cycles at Peking University People’s Hospital from January 1,2017 through December 31,2017.Oocyte maturation was triggered by GnRH combined with hCG(n=110)or hCG alone(n=71).Embryos were transferred on the third day after oocyte retrieval or during a subsequent freeze-thaw cycle.Patients were followed up for 3 years.Results The dual trigger treatment did not affect CLBR,which is an overall determinant of the success rate of assisted reproductive technology(ART).Women in the dual trigger group had significantly higher rates of fertilization than those in the hCG group(90.1%vs.83.9%,P=0.040).Conclusion Dual trigger with GnRH agonist and hCG did not improve CLBR in patients with DOR,but did slightly improve fertilization rate,oocyte count,and embryo quality.

Borderline form of empty follicle syndrome treated with a novel dual trigger method combined with delayed oocyte retrieval: A case report

BACKGROUND Borderline form of empty follicle syndrome is a condition in which only a few mature or immature oocytes are recovered after meticulous follicular aspiration,despite adequate ovarian response to stimulation.It is a rare phenomenon with an unclear cause.Currently,the condition still lacks effective treatment.CASE SUMMARY A patient with secondary infertility who had undergone three cycles of assisted reproductive technique(ART)is described.With regard to good follicular response,two oocytes were obtained in the first two ART cycles,but no embryo was formed.In the third ART cycle,which is the subject of this study,ovulation was induced by dual trigger of a supernormal dose of human chorionic gonadotropin(HCG)combined with a delayed oocyte retrieval approach.The method involved administration of gonadotropin-releasing hormone agonist,recombinant HCG,and urinary HCG 39 h before ovum pick-up.Ten oocytes were recovered,two out of three mature eggs were fertilized after intracytoplasmic sperm injection,resulting in two embryos that were subsequently cryopreserved.The case report guidelines have been used herein to present the first case of this novel dual trigger method.CONCLUSION This approach provides a new treatment option for patients with a similar condition in the future.This study can also inspire further investigation on the effects of variousβ-HCG serum levels 36 h after intramuscular HCG administration.

Dual Trigger in <i>in Vitro</i>Fertilization: A Case-Control Study

Objective: To evaluate the benefit of dual trigger (hCG + GnRH agonist) in patients underwent controlled ovarian stimulation for IVF in an antagonist protocol. Methods: A retrospective case control study was performed (January 2017 to March 2019) in a single IVF center. The dual trigger group (n = 17), ovulation trigger was achieved with both hCG and GnRH agonist while in the single trigger group (n = 34), it was achieved by hCG alone. The first endpoint was the number of mature oocytes retrieved;the secondary endpoints were total number of oocytes retrieved, the number of cleaved embryos obtained (day 3) and blastocysts (day 5/day 6), the number of embryos transferred, the ongoing-pregnancy/miscarriage rate. Results: The dual vs. the single group showed the followings. The number of retrieved oocytes of 7.1 vs. 6.4 (p = 0.68);mature oocytes of 4.6 vs. 4.1 (p = 0.62), day-3-embryos of 2.9 vs. 2.0 (p = 0.2), day-5/6-embryos of 0.3 vs. 0.03 (p = 0.13), transferred embryos of 2.1 vs. 1.8 (p = 0.48);ongoing pregnancy of 1 vs. 9 (p = 0.14);miscarriage of 0 vs. 2 (p = 1). Conclusion: A dual trigger showed no additional clinical benefits. Future large studies are needed to demonstrate a real clinical advantage.