Dual Trigger for Final Oocyte Maturation Yields Favorable Embryo Quality and Pregnancy Rates in Short IVF Protocols

Introduction:
Dual trigger (GnRH-a + HCG) for oocyte final maturation during short antagonist protocol was shown to decrease severe ovarian hyper stimulation syndrome (OHSS) prevalence without reducing pregnancy rates. In our center, we now routinely use the dual trigger for normal responders while HCG trigger alone is used in short agonist cycles.

Aim:
To investigate whether dual triggering for final oocyte maturation improves outcome in short protocols in IVF cycles in normal responder patients.

Materials & Methods:
A retrospective cohort study consisted of all 600 patients treated with short IVF cycles at Hadassah Medical Center from 1/12/2016 through 1/12/2017. Patients were divided into two groups according to their final oocyte maturation trigger.

Results:
During the study period, 360 patients were treated with dual trigger and 240 patients treated with HCG trigger. The dual trigger patients were younger compared to the HCG trigger (34.45 and 40.46 years respectively, P<0.05). Dual trigger group yielded significantly more oocytes (10.3±7.3and4.8±3.9 respectively, P<0.05)and MII oocytes (7.2±5.2 and 3.8±3.2 respectively, P<0.05). However, the fertilization rate was similar (0.66±0.3 and 0.61±0.3 respectively, p=0.09). Pregnancy rate is significantly higher in the dual trigger group (31.2% and 17.5% respectively, P<0.05).

Conclusions:
Dual trigger for final oocyte maturation in normal responders yields more oocytes and embryos per retrieval. . Furthermore, there was a higher pregnancy rate in this protocol. Although the study lacks the randomization of the groups, we showed that dual trigger is a good and safe option with better embryological and clinical results.