Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders

Objective: To compare live birth rates after dual trigger of oocyte maturation with GnRH agonist (GnRHa) and low-dose hCG versus GnRHa alone in high responders with peak E-2 < 4,000 pg/mL at risk of ovarian hyperstimulation syndrome (OHSS). Design: Retrospective cohort study. Setting: University-based tertiary-care fertility center. Patient(s): Patients < 40 years old with peak E2 < 4,000 pg/mL at risk of OHSS who underwent IVF/intracytoplasmic sperm injection with GnRH antagonist protocol and triggered with GnRHa alone or GnRHa plus 1,000 IU hCG (dual trigger) for oocyte maturation. Intervention(s): GnRHa alone versus dual trigger. Main Outcome Measure(s): Live birth, implantation, and clinical pregnancy rates and OHSS. Result(s): The dual-trigger group had a significantly higher live birth rate (52.9% vs. 30.9%), implantation rate (41.9% vs. 22.1%), and clinical pregnancy rate (58.8% vs. 36.8%) compared with the GnRHa trigger group. One case of mild OHSS occurred in the dual-trigger group, and there were no cases of OHSS in the GnRHa trigger group. Conclusion(s): Dual trigger of oocyte maturation with GnRHa and low-dose hCG in high responders with peak E2 < 4,000 pg/mL improves the probability of conception and live birth without increasing the risk of significant OHSS. (Fertil Steril (R) 2012; 97: 1316-20. (C) 2012 by American Society for Reproductive Medicine.)