Agonist trigger: what is the best approach? Agonist trigger with aggressive luteal support

Area of Science:

• Reproductive Endocrinology
• Infertility Treatments
• Assisted Reproductive Technology

Background:

• Gonadotropin-releasing hormone agonist (GnRHa) trigger is used to prevent ovarian hyperstimulation syndrome (OHSS).
• While effective for OHSS prevention, GnRHa triggers have been associated with reduced conception rates.
• Intensive luteal phase support is recognized for improving implantation rates in women with elevated peak estradiol (E2) levels (≥ 4,000 pg/mL).

Purpose of the Study:

• To investigate the efficacy of a dual trigger strategy in improving implantation rates.
• To determine optimal triggering protocols for patients undergoing assisted reproductive technology (ART).
• To evaluate the role of luteal phase support in conjunction with dual triggering for specific patient subgroups.

Main Methods:

• Retrospective analysis of ART cycles.
• Comparison of outcomes between different triggering protocols (GnRHa alone vs. dual trigger with GnRHa and hCG).
• Stratification of patients based on peak E2 levels (<4,000 pg/mL vs. ≥ 4,000 pg/mL).

Main Results:

• Patients with peak E2 levels <4,000 pg/mL may benefit from a dual trigger (GnRHa + 1,000 IU hCG).
• Intensive luteal phase support is crucial for enhancing implantation rates in conjunction with the dual trigger.
• This combined approach aims to mitigate lower conception rates associated with GnRHa triggers.

Conclusions:

• A dual trigger combining GnRHa and hCG, along with intensive luteal phase support, may be a viable strategy for improving implantation rates in patients with peak E2 levels below 4,000 pg/mL.
• This approach could offer a solution to the reduced conception rates sometimes observed with GnRHa-only triggers.
• Further research may be warranted to confirm these findings and optimize ART protocols.