Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates

• Published in: Fertility and sterility Vol. 102; no. 2; pp. 405 - 409
• Main Authors: Griffin, Daniel, Feinn, Richard, Engmann, Lawrence, Nulsen, John, Budinetz, Tara, Benadiva, Claudio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014
• Subjects: Adult; Chi-Square Distribution; Chorionic Gonadotropin - adverse effects; Chorionic Gonadotropin - therapeutic use; Drug Therapy, Combination; Dual trigger; Embryo Implantation; Embryo Transfer; Female; Fertility - drug effects; Fertility Agents, Female - adverse effects; Fertility Agents, Female - therapeutic use; Fertilization in Vitro; Gonadotropin-Releasing Hormone - agonists; Gonadotropin-Releasing Hormone - metabolism; gonadotropin-releasing hormone agonist; Humans; Infertility - diagnosis; Infertility - drug therapy; Infertility - metabolism; Infertility - physiopathology; Internal Medicine; in vitro fertilization; Logistic Models; Obstetrics and Gynecology; Odds Ratio; oocyte maturity; Oocyte Retrieval; Oocytes - drug effects; Oocytes - metabolism; Ovulation - drug effects; Ovulation Induction - adverse effects; Ovulation Induction - methods; Pregnancy; Pregnancy Rate; Retrospective Studies; Risk Factors; Treatment Outcome; gonadotropin-releasing hormone agonist; Dual trigger; in vitro fertilization; oocyte maturity
• ISSN: 0015-0282; 1556-5653; 1556-5653
• DOI: 10.1016/j.fertnstert.2014.04.028

To evaluate the percentage (%) of mature oocytes retrieved in patients with a previous history of >25% immature oocytes retrieved who were triggered with gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) to induce oocyte maturation. Retrospective cohort study. A university-based tertiary fertility center. Patients with a history of >25% immature oocytes retrieved in a prior in vitro fertilization cycle who were triggered with GnRH-a and hCG 5,000 IU or 10,000 IU in a subsequent cycle from January 2008 through February 2012. Dual trigger of GnRH-a and hCG 5,000 or 10,000 IU. Percent of mature oocytes retrieved and fertilization rate. The proportion of mature oocytes retrieved was significantly higher with a dual trigger compared with the subject's previous cycle (75.0%, interquartile range 55.6%–80.0% vs. 38.5%, interquartile range 16.7%–55.6%). The odds of a mature oocyte retrieved for patients who received a dual trigger was 2.51 times higher after controlling for stimulation protocol, hCG dose, gonadotropin dose, and oocyte retrieval time interval (odds ratio 2.51; confidence interval 1.06–5.96). The implantation, clinical, and ongoing pregnancy rates for the dual trigger were 11.8%, 26.1%, and 17.4%, respectively. In patients with a low percentage of mature oocytes retrieved who are triggered with a combination of GnRH-a and hCG, the % of mature oocytes retrieved improved. in vitro fertilization outcomes, however, remain poor, suggesting an underlying oocyte dysfunction.