Effect of Ovarian Stimulation and Trigger Protocols on Oocyte and Embryo Numbers-Real World Experience

Objectives: This retrospective single-center cohort study aims to evaluate the impact of dual-trigger therapy (recombinant hCG [rhCG] combined with GnRH agonist) compared to rhCG alone on ART outcomes in women undergoing GnRH antagonist protocols. Methods: Data from 1291 IVF cycles performed between 2016 and 2022 were analyzed. After propensity score matching (PSM) to adjust for confounders, 395 cycles in each group were compared. Primary outcomes included the total number of oocytes retrieved, while secondary outcomes assessed mature oocytes, fertilization rates, and embryo numbers. Results: Dual-trigger therapy yielded significantly more total oocytes (7.50 ± 5.23 vs. 6.12 ± 4.23, p < 0.001) and mature oocytes (5.67 ± 3.87 vs. 5.01 ± 3.13, p = 0.047) compared to rhCG alone. Cycles with no oocytes were fewer in the dual-trigger group (1.3% vs. 3.8%, p = 0.015). Total embryos were also higher with dual trigger therapy (2.43 ± 1.90 vs. 2.00 ± 1.93, p = 0.001). In intracytoplasmic sperm injection (ICSI) cycles, the fertilization rate significantly improved with dual trigger (64.93 ± 33.50% vs. 52.22 ± 34.12%, p = 0.003). No significant differences were noted in fertilization rates for standard IVF (55.14 ± 30.72% vs. 52.29 ± 32.11%, p = 0.18) or maturation rates (72.52 ± 26.91% vs. 71.53 ± 24.75%, p = 0.37). Conclusions: These findings demonstrate that dual-trigger therapy improves ART outcomes by increasing oocyte and embryo yields.