DOES DUAL TRIGGER IMPROVES REPRODUCTIVE OUTCOMES IN VITRO FERTILIZATION CYCLES?

Problem statement-Dual-trigger has been indicated for final oocyte maturation but studies regarding its possible benefits in patients undergoing assisted reproductive technology are conflicting. Therefore, this study aimed to evaluate if dual trigger compared to the standard hCG trigger improves reproductive outcomes in cycles within the same patient.

Methods-In this retrospective cohort study all in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles between January 2022 to June 2023 performed at Infertility Division of Maternidade Alfredo da Costa–CHULC were evaluated and only included women who first underwent a hCG trigger cycle and a subsequent dual trigger cycle. The outcomes of the dual trigger cycles were compared to the results of the hCG trigger cycles for the same patient. Primary outcomes were number of retrieved oocytes, number of mature oocytes, maturation rate, fertilization rate and number of top-quality embryos. Statistical analysis was performed using the SPSSv21.0 and p<.05 was considered statistically significant.

Results- Following inclusion criteria a total of 70 patients were included in the study.

Comparisons between the two groups revealed no difference in patient age (35,3 vs 36,0;p>.05), body mass index (24,92 vs 24,91kg/m2;p>.05), basal FSH (7,5 vs 7,1mIU/mL; p>.05), antral follicle counts (10,56 vs 9,71;p>.05) and Anti-Müllerian hormone (1,39 vs 1,25ng/mL;p>.05).

Also, there were no significant differences in terms of stimulation duration, types of gonadotropins used, despite of total dose of gonadotropins (2295 vs 2512UI;p<.05) were higher in the dual trigger group. Oocyte maturation and fertilization rates were identical in both groups but clinical pregnancy rate was higher in dual trigger group (15,7% vs 4,3%;p <.05). In a subgroup analysis taking account only patients who had a maturation rate of <60% following hCG triggering (n=23), there was a significantly higher number of retrieved oocytes (3,8 vs 5,9;p<.05), number of mature oocytes (1,7vs 4,3;p<.05), maturation rate(32% vs 75%;p<.05) and top-quality embryos following dual trigger (16 vs 38, p<.05).

Conclusion- Dual trigger for final oocyte maturation increases the oocyte maturation rate in women who had a low oocyte maturation rate following standard hCG triggering and therefore should be considered when oocyte maturation rate following standard hCG triggering is lower than 60%.