#210 : The Comparison of Agonist Trigger and Dual Trigger in Our IVF Population - A Single Center Retrospective Study

Abstract

Background: For years, human chorionic gonadotropin (hCG) has been the trigger of choice for oocyte maturation due to its molecular and biological similarity with LH, but its longer half-life compared to LH contributes to the ovarian hyperstimulation syndrome (OHSS) in hyper responders. Besides, hCG lacks FSH activity, which plays a role in the in vitro maturation of oocytes. Gonadotropin-releasing hormone (GnRH) agonists which can bring endogenous release of both FSH and LH and have a shorter mean duration of LH surge, and effectively reduce the incidence of OHSS in high responders. However, the substitution of agonist as trigger is associated with the risk of empty follicle syndrome, increased early pregnancy loss and decreased rates of ongoing pregnancy. The idea of a dual trigger where hCG component could serve as a rescue in case of poor response to GnRH-agonist, occurring in about 2.71% of ART population, and agonist bringing FSH & LH surge simultaneously leading to improved oocyte quality was the basis for present study. Aim & objective: To observe the difference between agonist trigger and dual trigger in various ovarian reserve groups. Materials & Methods: Retrospective cohort study in patients attending Eva fertility clinic & IVF center between 2021-2022. Total patients =157 agonist trigger =57 dual trigger = 100 Age: 24 years to 41 years Average BMI 26 AMH :2.0 ng-6.6 ng/ml Primary outcome: Clinical pregnancy rate & ongoing pregnancy rate Secondary outcome: Blastocyst formation rate Total M2 achieved. Result: Pregnancy’ in (AMH: 5 ng/mL)- no significant difference ([Formula: see text]2= 0.286, p = 0.711). (Table 3) Limitation of the study- small sample size, lack of plain hCG trigger group to compare as an arm 3. Conclusion: Dual trigger treatment with GnRH agonist and hCG is not inferior in terms of live birth rate, blastocyst, & M2 oocytes compared to GnRH agonist & hCG trigger apart from avoiding the danger of OHSS.