Effect of dual trigger on pregnancy outcomes in women with diminished ovarian reserve: A single-blind randomized clinical trial.

BACKGROUND

Diminished ovarian reserve is one of the most important issues in in vitro fertilization cycles. Some authors have reported beneficial effects of dual triggering in women with poor ovarian response, whereas other investigators have demonstrated contrary results.

OBJECTIVE

The study aims to investigate the effect of final follicular maturation using a dual trigger (human chorionic gonadotropin [HCG] plus gonadotropin-releasing hormone [GnRH] agonist) compared to HCG alone in GnRH-antagonist cycles on oocyte retrieval, maturation, embryo quality, and clinical pregnancy in frozen cycles.

MATERIALS AND

METHODS

This single-blind randomized clinical trial was conducted from May and November 2019 on 80 infertile women with poor ovarian response undergoing an intracytoplasmic sperm injection-embryo transfer cycle with a GnRH-antagonist protocol. All participants received 10,000 IU of urinary HCG for final oocyte maturation. The dual trigger group received an additional 0.2 mg of triptorelin acetate, while the HCG alone group did not. The primary outcome was the clinical pregnancy rate. Secondary outcomes included the number of oocytes retrieved, mature oocytes, fertilization rate, embryo quality, implantation rate, and miscarriage rate.

RESULTS

The dual trigger group showed a significantly higher number of total oocytes, metaphase II oocytes, good-quality embryos, and implantation rate compared to the HCG alone group (p ≤ 0.050). However, no significant difference was observed between the groups in clinical pregnancy or abortion rates (p > 0.050).

CONCLUSION

Final oocyte maturation using a dual trigger (GnRH agonist + HCG) improves the number of good-quality embryos and can be a practical approach to enhance the efficiency of the fertilization process in infertile women with diminished ovarian reserve.