The Trigger Effect of GnRH Agonist Repeated Dose on Intracytoplasmic Sperm Injection Outcomes: A Randomized Single-Blinded Clinical Trial.

PURPOSE: The optimal GnRH agonist (GnRHa) dosing for ovulation triggering remains controversial, particularly regarding oocyte competence versus OHSS mitigation. Here, we analyzed the repeated dose of GnRHa as a trigger of ovulation on intracytoplasmic sperm injection (ICSI) results.

METHODS

This single-blinded randomized clinical trial was conducted on 362 ICSI candidates who met the inclusion criteria. The subjects underwent the antagonist protocol and based on the received trigger, were divided into two groups: single dose (group A) and repeated dose (group B) of GnRHa. Demographic and clinical data were collected and analyzed using SPSS-24.

RESULTS

Repeated dosing of GnRH increased M2 oocyte numbers yield by 22.84% ± 6.92% (95% CI: 9.23-25.38, p = 0.001). Also, the maturity rate (p = 0.001), the number of pronuclear embryos (p = 0.001), and the number of good and excellent quality embryos (p = 0.004) were higher in group B. Empty follicle syndrome was presented in no cases. Despite the high ovarian response, no OHSS cases were reported (mean oocytes> 17 ± 8). There was no significant difference regarding premature ovulation, use of Cabergoline, chemical and clinical pregnancy, miscarriage, and live birth rates between the 2 study groups.

CONCLUSION

It seems that the administration of the second dose of GnRHa 12 h after the first dose leads to better oocyte maturation and higher quality embryos.

TRAIL REGISTRATION: IRCT20081007001306N11; https://irct.behdasht.gov.ir/trial/60387.