Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Abstract

The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro fertilisation (IVF) cycles. The concept being a ‘‘dual trigger’’ combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ‘‘double trigger” represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 h prior to ovum pick-up, respectively. The use of the ‘‘double trigger” has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation.

Chinese abstract

本综述的目的是分析促性腺激素释放激素 (GnRH) 激动剂与人绒毛膜促性腺激素 (hCG) 联合诱发体外受精 (IVF) 周期中的最终卵母细胞成熟。该概念是”双重触发”在触发时将单剂量的GnRH激动剂与减少的或标准剂量的hCG联合。在高反应者中使用具有减少剂量hCG的GnRH激动剂显示出具有改善的妊娠率的黄体期支持, 类似于常规hCG之后, 并且低风险的卵巢过度刺激综合征 (OHSS) 。在正常应答者中应用GnRH激动剂和标准hCG, 显示出明显改善的活产率和更高数量的优质胚胎或冷冻保存的胚胎。当在卵子接种前40和34小时使用时, ”双重触发”的概念分别表示GnRH激动剂和标准hCG的联合。”双重触发”的使用已经成功地用于治疗空卵泡综合征和具有未成熟卵母细胞病史或具有低/劣卵母细胞产量的患者。需要进一步的前瞻性研究以确认在临床实施前的上述观察结果。

Keywords:

• Combined ovulation triggering
• double trigger
• dual trigger
• GnRH agonist trigger
• hCG-triggering

Declaration of interest

The authors report no declarations of interest.