Abstract
Background: Infertility is one of the major medical problems in the world which has led to continuous research
and advances in the field of assisted reproductive technology (ART),
Aim of the work: to investigate whether co-administration of GnRH-a and hCG for final oocyte maturation (dual
trigger) would improve number of oocytes retrieved& its
quality and eventually IVF/ICSI clinical outcomes compared to single triggers in women with normal ovarian
response undergoing (IVF/ICSI) technique using GnRH
antagonist protocol of stimulation.
Patients and Methods: A total 120 patients were included in this study, randomized and divided into two groups:
Group (1): The study group; included 60 patients who received the dual trigger. Group (2): The control group; who
included 60 patients, age matched, who received the hCG
trigger alone. All participants were subjected to proper
history taking, complete general, abdominal and pelvic
examination, and full investigations to confirm criteria
of the study. All participants were subjected to controlled
ovarian hyper stimulation protocol according to GnRH
antagonist protocol starting on day 2-3 of the menstrual
cycle with a starting daily administration of FSH, human
menopausal gonadotropin hMG, or highly purified hMG,
or highly purified FSH or with recombinant FSH (r.FSH)
intramuscularly for 4–5 days, and continued until the day
of final oocyte maturation injection.
Results: the current study showed statistically significant difference with p-value <0.05 between study groups
as regards to the number of retrieved oocytes (cases:
11.42±4.2 vs. control: 9.8±4.9), number of MII oocyte retrieved (dual trigger: 6.2±2.7 vs. single trigger: 4.6±3.1),
and number of fertilized oocyte (dual trigger: 4.03±2.2 vs.
single trigger: 3.05±2.5) with higher mean among dual
trigger group. In the current study also the dual-trigger
group demonstrated a significantly higher percentage as
regards to biochemical pregnancy rate (cases: 68.3%vs.
33.3% among controls), clinical pregnancy rate (cas-
es: 58.3% vs. 31.7% among controls) and
implantation rate (cases: 41.3% vs. 21.4%
among controls) with a statistically significant difference with p-value <0.05 between
study groups. Both groups showed no statistically significant difference as regards
to the mean number of embryos transferred
(1.9±1.01 in cases vs. 1.7±1.2 in control)
and number of frozen embryos (1.33±1.08 in
cases vs. 1.1±1.4 in control), or as regards
to complications; whether ET cancellation or
incidence of sever OHSS.
Conclusion: In conclusion, in terms of the
number of mature retrieved oocytes, implantation rate and clinical pregnancy rate in normal responders undergoing IVF/ICSI using
antagonist protocols, a dual-trigger approach
with a GnRH agonist and the standard dosage of hCG was found to be significantly superior to an hCG trigger alone.