Over the past two decades, the success rates of ART have dramatically increased. The increase has largely been attributed to improvements in laboratory conditions. More recently there has been attention directed toward physician dependent decisions to further improve outcomes. In this presentation we will focus how we can improve IVF outcomes by modifying the trigger to attain a more physiologic mechanism for inducing final oocyte maturation. We will review the physiology and the current literature on different types of trigger with comparison to the conventional approach.