Safety and effectiveness of dual trigger (GnRH agonist + HCG) versus HCG alone in patients with high ovarian response

To compare the safety and effectiveness between long-term GnRH agonist plus HCG (dual trigger) and HCG trigger alone in high ovarian responders.

A retrospective study was conducted on clinical data from 314 cases of high ovarian response who underwent in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at Hunan Provincial Maternal and Child Healthcare Hospital from July 2018 to January 2023. Participants were divided into two groups based on their triggering regimen: the Combined treatment group (GnRH agonist + HCG) and the HCG group (HCG alone). Blood routine, ovary ultrasound parameters, baseline hormone levels, clinical outcomes of controlled ovarian stimulation, clinical outcomes of the first transplantation, and incidence of ovarian hyperstimulation syndrome (OHSS) were compared between the two groups.

There were no significant differences in patient characteristics, blood routines, ovary ultrasound parameters, clinical pregnancy rate, implantation rate and abortion rate between the two groups (all P > 0.05). However, the incidence of Ovarian Hyperstimulation Syndrome (OHSS) in combined treatment group was significantly lower than that in HCG group (mild OHSS: 31% vs. 46.26%, P=0.015; moderate/severe OHSS: 3.00% vs. 11.68%, P=0.021).

Long-term GnRH agonist plus HCG (dual trigger) does not affect the number of metaphase II (MII) oocytes, high-quality embryos, or clinical pregnancy rate in patients with high ovarian response. Furthermore, the incidence of OHSS is significantly lower with the dual trigger compared to the HCG trigger alone.