SINGLE VERSUS DOUBLE AGONIST TRIGGER IN ANTAGONIST PROTOCOL CYCLES: A MULTICENTER PROSPECTIVE AND RETROSPECTIVE STUDY

Abstract

Background: The use of GnRH agonist (GnRHa) to induce final oocyte maturation in IVF has become increasingly common due to its proven ability to reduce the incidence of OHSS. It has previously been demonstrated that the LH surge induced by a single bolus of GnRHa at mid-cycle results in a shorter LH surge than in natural cycles. There has been concern, that the GnRHa-induced LH surge may not adequately induce maturation of the oocytes. Objective: The aim of this study is to establish if a second dose of GnRHa repeated 12 h following the initial dose optimizes the cycle outcome in terms of  ongoing pregnancy rate in women undergoing intracytoplasmic sperm injection (ICSI) cycles using a GnRH‐antagonist protocol. Methods: This prospective and retrospective study included 160 women, they were divided into two groups, group (A) 80 subjects were triggered by a single dose of 0.3 mg GnRH agonist triptorelin subcutaneously 36 h prior to oocyte retrieval. Group (B) 80 subjects were triggered by 2 doses of GnRH agonist triptorelin the first as in group A + a second dose of 0.2 mg 12 h following the 1st dose. 12 h & 24 h post-trigger luteinizing hormone (LH) values were estimated. 25 patients were followed prospectively and the data of 55 patients was collected retrospectively in each group. Results: there was a statistical significant difference between both groups in favor of group (B) as regard ongoing pregnancy rate and implantation rate, but there was no significant statistical difference as regard oocyte maturity rate, clinical pregnancy rate and OHSS occurence. Conclusion: the double dose GnRHa trigger offers better ongoing pregnancy rate than single dose GnRHa trigger but their efficacy is comparable regarding clinical pregnancy rate, oocyte maturity rate and OHSS occurrence.