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

ObjectiveTo 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 E2 <4,000 pg/mL at risk of ovarian hyperstimulation syndrome (OHSS).DesignRetrospective cohort study.SettingUniversity-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.