Does “Dual Trigger” Increase Oocyte Maturation Rate?

Introduction: The LH activity of hCG replaces the preovulatory LH peak and is more prolonged, whereas GnRH-a triggering reproduces the more physiological dual LH and FSH peak.The effect of the simultaneous co-administration of GnRH-a and hCG 36-38 hours prior to oocyte pick-up (dual trigger) on oocyte maturity rates was evaluated in a few studies reaching conflicting results.

Aim: Does the co-administration of GnRH agonist (GnRH-a) and hCG for final oocyte maturation triggering increase the oocyte maturation rate in comparison to the standard hCG trigger?

Materials and methods: Retrospective analysis of GnRH antagonist ICSI cycles performed in patients who had one standard hCG trigger cycle and one dual trigger cycle and fresh ETs between 1/1/2013 and 31/12/2017. The study included 136 patients. The outcome of the dual trigger cycles was compared to results of the hCG trigger cycles in the same patients.

Results: Overall, oocyte maturation rate was identical in both groups (81%). Among 34 patients who had a maturation rate of <70% following hCG triggering, there was a significantly higher oocyte maturation rate following dual trigger (54% versus 74%, p<0.001). Among 16 patients with a lower than 50% oocyte maturation rate following hCG trigger, there was a significantly higher maturation rate following dual trigger (44% versus 73%, p=0.006).

Conclusions: The co-administration of GnRH agonist and hCG for final oocyte maturation substantially increases the oocyte maturation rate in patients who had a low oocyte maturation rate in a previous hCG triggered cycle, but not in an unselected population of patients.