Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates.
OBJECTIVE
To evaluate the percentage (%) of mature oocytes retrieved in patients with a previous history of >25% immature oocytes retrieved who were triggered with gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) to induce oocyte maturation.


METHODS
Retrospective cohort study.


METHODS
A university-based tertiary fertility center.


METHODS
Patients with a history of >25% immature oocytes retrieved in a prior in vitro fertilization cycle who were triggered with GnRH-a and hCG 5,000 IU or 10,000 IU in a subsequent cycle from January 2008 through February 2012.


METHODS
Dual trigger of GnRH-a and hCG 5,000 or 10,000 IU.


METHODS
Percent of mature oocytes retrieved and fertilization rate.


RESULTS
The proportion of mature oocytes retrieved was significantly higher with a dual trigger compared with the subject's previous cycle (75.0%, interquartile range 55.6%-80.0% vs. 38.5%, interquartile range 16.7%-55.6%). The odds of a mature oocyte retrieved for patients who received a dual trigger was 2.51 times higher after controlling for stimulation protocol, hCG dose, gonadotropin dose, and oocyte retrieval time interval (odds ratio 2.51; confidence interval 1.06-5.96). The implantation, clinical, and ongoing pregnancy rates for the dual trigger were 11.8%, 26.1%, and 17.4%, respectively.


CONCLUSIONS
In patients with a low percentage of mature oocytes retrieved who are triggered with a combination of GnRH-a and hCG, the % of mature oocytes retrieved improved. in vitro fertilization outcomes, however, remain poor, suggesting an underlying oocyte dysfunction.
Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
Daniel
D
Griffin
Department of Biostatistics, University of Connecticut Health Center, Farmington, Connecticut.
Richard
R
Feinn
Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
Lawrence
L
Engmann
Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
John
J
Nulsen
Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
Tara
T
Budinetz
Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut. Electronic address: benadiva@up.uchc.edu.
Claudio
C
Benadiva
D000328:Adult; D016009:Chi-Square Distribution; D006063:Chorionic Gonadotropin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000378:metabolism; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D016015:Logistic Models; D016017:Odds Ratio; D054315:Oocyte Retrieval; D009865:Oocytes / Q000187:drug effects* / Q000378:metabolism; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone
Dual trigger; gonadotropin-releasing hormone agonist; in vitro fertilization; oocyte maturity