Comparative study between single versus dual trigger for poor responders in GnRH-antagonist ICSI cycles: A randomized...

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Poor responders often exhibit suboptimal outcomes in IVF-ICSI cycles.
• Standard ovulation triggering protocols may not be sufficient for maximizing oocyte yield and pregnancy rates in this patient group.

Purpose of the Study:

• To evaluate the efficacy of dual-triggering (GnRH agonist + hCG) versus single-triggering (hCG alone) for final oocyte maturation in poor responders undergoing IVF-ICSI with a GnRH-antagonist protocol.
• To assess the impact on oocyte retrieval, embryo development, and pregnancy rates.

Main Methods:

• A randomized controlled trial involving 160 poor responders undergoing IVF-ICSI with a GnRH-antagonist protocol.
• Participants were randomized to receive either dual-triggering (hCG + triptorelin) or single-triggering (hCG alone).
• Key outcomes included oocyte retrieval, metaphase II oocytes, embryo quality, cancellation rates, and pregnancy rates.

Main Results:

• Dual triggering resulted in a significantly higher number of retrieved oocytes (5.3 vs 4.5) and metaphase II oocytes (3.8 vs 3.1) compared to single triggering.
• The dual-trigger group showed improved total and grade 1 embryo development (2.7 and 2.3 vs 1.9 and 1.1) and a lower cancellation rate (7.5% vs 20%).
• Significantly higher chemical (25% vs 11.3%) and clinical pregnancy rates (22.5% vs 8.8%) were observed with dual triggering.

Conclusions:

• Dual triggering with GnRH agonist and hCG is associated with superior IVF outcomes in poor responders compared to hCG alone.
• This strategy enhances oocyte yield, embryo quality, and pregnancy success rates in challenging IVF cases.