Does Double Trigger (GnRH Agonist + hCG) Improve Outcome in Poor Responders Undergoing IVF-ET Cycle? A Pilot Study

Objective: Many strategies are offered for the treatment of poor responders. However, no compelling advantage for one stimulation protocol over another has been hitherto established. In the present study we aimed to evaluate the role of different modes and timings of final follicular maturation trigger on IVF cycle outcome of poor responder patients.

Design: A prospective randomized controlled study.

Materials and Methods: Poor responder patients, according to the Bologna criteria, undergoing controlled ovarian hyperstimulation (COH) using the GnRH antagonist protocol were randomly assigned to 3 different final follicular maturation trigger modes and timings: 1. hCG Trigger - hCG 36 hours before oocyte pick-up (OPU); 2. GnRHa Trigger - GnRH-agonist 36 hours before OPU and hCG on day of OPU; 3. Double Trigger - GnRHa and hCG, 40 hours and 34 hours prior to OPU, respectively.

Results: Patients characteristics and COH variables are shown in the table:

Patients undergoing the Double trigger demonstrated a trend toward a higher number of top quality embryos (TQE) with an acceptable pregnancy rate.

Conclusions: Double trigger offers an additional benefit to poor responder patients. Larger studies are required to support this new concept prior to its implementation to IVF practice.