Does double trigger (GnRH-agonist + hCG) improve outcome in poor responders undergoing IVF-ET cycle? A pilot study

Abstract

Many strategies are offered for the treatment of poor responders. However, no compelling advantage for one stimulation protocol over another has been hitherto established. In this study, we aimed to evaluate the role of different modes and timings of final follicular maturation trigger, on in vitro fertilization (IVF) cycle outcome of poor responder patients. In the present randomized controlled study, poor responder patients, according to the Bologna criteria, undergoing controlled ovarian hyperstimulation (COH) using the gonadotropin-releasing hormone (GnRH) antagonist protocol were randomly assigned to three different final follicular maturation trigger modes and timings: hCG 36 h before oocyte pick-up (OPU) (hCG trigger); GnRH agonist (GnRHag) 36 h before (OPU) and hCG on day of OPU (GnRHag trigger); and GnRHag and hCG, 40 and 34 h prior to OPU, respectively (double trigger). Pregnancy rate, number of oocytes, and top quality embryos (TQEs). Thirty-three poor responder patients were recruited and randomized to the different study groups. While there were no in-between groups’ differences in patients’ demographics and stimulation variables, patients in the double trigger group had a significantly higher number of TQE (1.1 ± 0.9 vs. 0.3 ± 0.8 and 0.5 + 0.7; p<.02) as compared to the hCG trigger and the GnRH-ag trigger groups, respectively, with an acceptable pregnancy rate. Double trigger offers an additional benefit to poor responder patients. Larger studies are required to support this new concept prior to its implementation to IVF practice.

Trial registration: ClinicalTrials.gov identifier: NCT02144818.

摘要：

针对低反应患者提供了许多治疗方案。然而, 到目前为止, 还没有一种具有明显优势的方案。在这项研究中, 我们的目的是评估不同的方案和最终卵泡成熟触发时间, 对在体外受精(IVF)周期中低反应患者结局的作用。在目前的随机对照研究中, 根据博洛尼亚标准定义的低反应患者,他们都是接受促性腺激素释将放激素(GnRH)拮抗剂方案的控制性超促排卵（COH）患者, 根据最终滤泡成熟触发方案和应用时间, 被随机分配到三个组：取卵(OPU)前36小时应用HCG (hCG触发);取卵前36h (OPU)应用 GnRH激动剂(GnRHag);OPU前40小时和34h分别应用GnRHag和hCG(双触发)。比较妊娠率、卵母细胞数、优质胚胎(TQEs)。研究中共招募了33例低反应患者并随机分配到不同的研究组。各组间患者的人口统计学和刺激变量无差异；与hCG触发组和GnRH-ag触发组相比, 双触发组的患者优质胚胎数显著升高(1.1 ± 0.9 vs. 0.3 ± 0.8 and 0.5þ0.7; p<.02), 有很好的妊娠率。双触发方案为反应差的患者提供了额外的好处。在将这一方案应用于IVF患者之前, 需要进行更大规模的研究来支持这一新的概念。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Assisted reproductive technology
• infertility
• ovulation induction
• poor responders
• pregnancy rate

Disclosure statement

No potential conflict of interest was reported by the authors.