The Co-Administration of hCG and GnRH Agonist (Dual Trigger) does Not Affect Early Embryo Early Morphokinetic Parameters

INTRODUCTION: Dual trigger was reported to increase oocyte maturation rate probably due to the simultaneous induction of FSH and LH surges. Treatment protocol and ovulation triggering medications have been shown to affect embryo development.

AIM: To evaluate the effect of dual triggering on embryo morphokinetic characteristics.

METHODS: A retrospective cohort study evaluating embryo morphokinetic parameters and cycle outcome in GnRH antagonist IVF-ICSI cycles triggered by dual (Decapeptyl 0.2mg + Ovitrelle 250 mcg) or standard hCG trigger (Ovitrelle 250 mcg) in women ≤42, between 4/2013-12/2016. Cleavage timings (t2-t8), second cell cycle duration (CC2) and synchrony (S2) were compared and KIDScore was used for assessing embryo quality. Multivariate logistic analysis was performed for confounding factors.

RESULTS: A total of 2,982 embryos; 229 (41 cycles) in the dual trigger and 2,753 (425 cycles) in the hCG trigger group, were analyzed. Groups were similar in patient and treatment characteristics: maternal age (34.8±5.3 and 34.2±5.4), number of oocytes aspirated (11.1±6 and 11±7) and oocyte maturation rate (85% and 84%) in the dual and hCG groups, respectively. Cleavage timings up to the 8-cell stage did not differ between the two groups after adjusting for maternal age, BMI, peak blood estradiol level and number of oocytes. The proportion of embryos with adequate CC2 (>5hours), optimal S2 (<1hour) and high (4/5) KIDScores, as well as pregnancy rates, were similar.

CONCLUSION: In GnRH antagonist cycles in unselected population, addition of a GnRH agonist to the hCG trigger does not affect embryonic morphokinetic parameters or embryo quality.