title: Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders.
abstract: OBJECTIVE
  To compare live birth rates after dual trigger of oocyte maturation with GnRH agonist (GnRHa) and low-dose hCG versus GnRHa alone in high responders with peak E(2) <4,000 pg/mL at risk of ovarian hyperstimulation syndrome (OHSS).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-based tertiary-care fertility center.
  
  
  METHODS
  Patients <40 years old with peak E(2) <4,000 pg/mL at risk of OHSS who underwent IVF/intracytoplasmic sperm injection with GnRH antagonist protocol and triggered with GnRHa alone or GnRHa plus 1,000 IU hCG (dual trigger) for oocyte maturation.
  
  
  METHODS
  GnRHa alone versus dual trigger.
  
  
  METHODS
  Live birth, implantation, and clinical pregnancy rates and OHSS.
  
  
  RESULTS
  The dual-trigger group had a significantly higher live birth rate (52.9% vs. 30.9%), implantation rate (41.9% vs. 22.1%), and clinical pregnancy rate (58.8% vs. 36.8%) compared with the GnRHa trigger group. One case of mild OHSS occurred in the dual-trigger group, and there were no cases of OHSS in the GnRHa trigger group.
  
  
  CONCLUSIONS
  Dual trigger of oocyte maturation with GnRHa and low-dose hCG in high responders with peak E(2) <4,000 pg/mL improves the probability of conception and live birth without increasing the risk of significant OHSS.
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Griffin
authors.forename: Claudio
authors.initials: C
authors.lastname: Benadiva
authors.forename: Nicole
authors.initials: N
authors.lastname: Kummer
authors.forename: Tara
authors.initials: T
authors.lastname: Budinetz
authors.forename: John
authors.initials: J
authors.lastname: Nulsen
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D010064:Embryo Implantation; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists / Q000031:analogs & derivatives*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000453:epidemiology; D008183:Luteal Phase / Q000502:physiology; D009865:Oocytes / Q000166:cytology* / Q000187:drug effects*; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D018873:Pregnancy Rate; D012102:Reproductive Control Agents / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006063:Chorionic Gonadotropin; D012102:Reproductive Control Agents; D007987:Gonadotropin-Releasing Hormone; C083781:LHRH, Ala(6)-Gly(10)-ethylamide-