Combined ovulation triggering with GnRH agonist and hCG in IVF patients.
The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro fertilisation (IVF) cycles. The concept being a ''dual trigger'' combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ''double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 h prior to ovum pick-up, respectively. The use of the ''double trigger" has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation.
a Department of Obstetrics and Gynaecology , University Hospital Centre Zagreb, School of Medicine, University of Zagreb , Zagreb , Croatia and.
Miro
M
Kasum
b Human Reproduction Unit, Maternity Hospital and Outpatient Clinic Podobnik , Zagreb , Croatia , and.
Kristijan
K
Kurdija
a Department of Obstetrics and Gynaecology , University Hospital Centre Zagreb, School of Medicine, University of Zagreb , Zagreb , Croatia and.
Slavko
S
Orešković
c Human Reproduction Unit, Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina.
Ermin
E
Čehić
a Department of Obstetrics and Gynaecology , University Hospital Centre Zagreb, School of Medicine, University of Zagreb , Zagreb , Croatia and.
Dinka
D
Pavičić-Baldani
a Department of Obstetrics and Gynaecology , University Hospital Centre Zagreb, School of Medicine, University of Zagreb , Zagreb , Croatia and.
Lana
L
Škrgatić
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists* / Q000494:pharmacology*; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone
Combined ovulation triggering; GnRH agonist trigger; double trigger; dual trigger; hCG-triggering