Reproductive outcomes after human chorionic gonadotropin compared with human chorionic gonadotropin with gonadotropin-releasing hormone agonist for the induction of final oocyte maturation in gnrh antagonist cycles

Objective: To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) can improve in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in gonadotropin-releasing hormone antagonist cycles. Design: Retrospective study. Setting: Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF (in vitro fertilization) unit. Material and method(s): This retrospective cohort study included women aged up to 41 years who underwent IVF/ICSI under GnRH antagonist protocol, between December 1 2017 and May 31 2018. Patients were grouped by whether oocyte maturation was triggered with GnRHa plus hCG (dual) or hCG alone. Study population included 295 women; 111 women who received hCG trigger and 184 women who received dual trigger. The study was approved by the ethics committee of, Faculty of Medicine, Akdeniz University. Result(s): There was no difference in baseline demographics of patient receiving hCG or hCG plus GnRHa. The study showed statistically insignificant differences between dual group versus hCG group in terms of the number of oocytes retrieved (P = 0,085), the number of mature oocytes (P = 0,092), fertilization rate (P = 0,792). The number of high-quality embryos (P = 0,002) was higher with dual group compared with hCG-only group, nevertheless, the clinical pregnancy and the live delivery rate did not differ significantly between the groups (P = 0,826). Male sex rate within live delivery was higher in dual trigger group compare with hcg-only group (P = 0,008). Conclusion(s): Dual trigger of oocyte maturation was associated with no change in the live delivery rate but was associated with improvements in the quantity and quality of embryos. More prospective studies involving large patient groups are needed to verify the results of this study. Key words: GnRH antagonist protocol, Dual trigger, Final oocyte maturation, GnRH agonist, Ovarian stimulation