title: Dual trigger with gonadotropin-releasing hormone agonist and recombinant human chorionic gonadotropin improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether dual trigger with leuprolide acetate plus recombinant human chorionic gonadotropin (hCG) improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles.
  
  
  METHODS
  A total of 156 patients diagnosed with mild male factor, unexplained or tubal factor infertility were enrolled in the study. All subjects were allocated into one of two groups: the dual trigger group (leuprolide acetate 500 μg + recombinant hCG 250 μg) and the standard group (recombinant hCG 250 μg) according to the selected trigger method. Oocyte trigger was performed when at least three follicles >17 mm were observed. Pregnancy rate, number of collected oocytes, number of metaphase II oocytes, number of grade-A embryos, cycle cancellation rate, and ovarian hyperstimulation syndrome rate were the main outcome measures for the study.
  
  
  RESULTS
  The mean number of grade-A embryos (1.6 ± 1.5 vs 1.1 ± 1.4, P = 0.01) and of metaphase II oocytes (7.9 ± 4.6 vs 6.3 ± 5.8, P = 0.02) was significantly higher in the dual-trigger group. Pregnancy rate was significantly higher in the dual-trigger group than in the standard group (54.8 vs 37.5%, P = 0.006). Two cases of mild ovarian hyperstimulation syndrome were observed in each group.
  
  
  CONCLUSIONS
  This novel and more physiological trigger approach using 500 μg leuprolide acetate plus 250 μg recombinant hCG may lead to an increase in the number of metaphase II oocytes, grade-A embryos, and may improve pregnancy rates.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey. seval@ankara.edu.tr.
authors.forename: Mehmet Murat
authors.initials: MM
authors.lastname: Seval
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.
authors.forename: Batuhan
authors.initials: B
authors.lastname: Özmen
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Atabekoğlu
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.
authors.forename: Yavuz Emre
authors.initials: YE
authors.lastname: Şükür
authors.affiliation: IVF unit, Ankara Liv Hospital, Ankara, Turkey.
authors.forename: Coşkun
authors.initials: C
authors.lastname: Şimşir
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.
authors.forename: Özgur
authors.initials: Ö
authors.lastname: Kan
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sönmezer
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D016729:Leuprolide / Q000627:therapeutic use; D008677:Metaphase / Q000187:drug effects; D009865:Oocytes / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide; C061018:ganirelix
keywords: clinical; female; assisted reproductive technology; infertility