Dual Trigger Compared with Human Chorionic Gonadotropin Alone and Effects on Clinical Outcome of Intracytoplasmic Sperm Injection

Document Type : Original Article


1 Department of Obstetrics and Gynaecology, Koc University Hospital, Istanbul, Turkey

2 Isfahan Fertility and Infertility Centre, Isfahan, Iran

3 Department of Obstetrics and Gynaecology, Koc University, Faculty of Medicine, Istanbul, Turkey


Background: This study compared outcomes of the standard 6000 IU human chorionic gonadotropin (hCG) trigger
with a dual trigger comprised of 6000 IU hCG and 1 mg leuprolide acetate for final oocyte maturation in an intracytoplasmic sperm injection (ICSI) cycle. By convention, ICSI was performed in most cases at the clinic.
Materials and Methods: In this retrospective study, a total of 50 women were included in each arm. Participants
were matched for age, indication and number of prior assisted reproduction technology (ART) cycles. Women at risk
for ovarian hyperstimulation syndrome (OHSS) were excluded. A flexible gonadotropin releasing hormone (GnRH)
antagonist protocol was used and final oocyte maturation was triggered when two leading follicles were >17 mm.
Distribution of variables was evaluated visually with histograms. Continuous variables were defined by mean (standard
deviation) or median (25th-75th percentile) depending on distribution characteristics. Categorical variables were
defined by numbers and percentages. Continuous variables were compared between the groups with the t test or
Mann-Whitney U test as appropriate. Categorical variables were compared by the chi-square test and its derivatives
as appropriate. A two-sided P<0.05 indicated statistical significance.
Results: Both groups had similar antral follicle counts, median parity (0) and number of previous failed cycles (0).
The median number of oocytes (8 vs. 7), metaphase-two oocytes (6 vs. 5.5), blastocysts (1 vs. 1), clinical pregnancy
rates (CPR) (28% vs. 22%), ongoing pregnancy rates (OPR) (22% vs. 20%) and pregnancy rate per transfer (53.3%
vs 53.8%) were similar between the dual trigger and hCG only groups, respectively.
Conclusion: Dual trigger for oocyte maturation stimulation failed to improve the ICSI outcome.


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