title: GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone.
abstract: OBJECTIVE
  The purpose of this study was to compare rates of ovarian hyperstimulation syndrome (OHSS) after using gonadotropin-releasing hormone agonists (GnRHa) alone and GnRHa in combination with low-dose human chorionic gonadotropin (hCG, dual trigger) for final oocyte maturation in women undergoing controlled ovarian hyperstimulation (COH).
  
  
  METHODS
  A retrospective cohort study was conducted at an academic center. Study population included 108 women who received GnRHa trigger and 66 women who received dual trigger (GnRHa + low-dose [1000 IU] hCG trigger). The main outcome measure was OHSS. Secondary outcomes included total oocyte yield and oocyte maturity.
  
  
  RESULTS
  The incidence of early OHSS was significantly higher after dual trigger than GnRHa trigger (8.6 vs 0 %). Moreover, four of the six patients that developed OHSS developed severe OHSS. Logistic modeling revealed that the combination of age, BMI, baseline AFC, and E2 >4000 pg/mL was predictive of OHSS with an area under the receiver operating characteristic curve of 0.84 and was superior to each factor alone. Adjusted analyses revealed that dual trigger was associated with a higher number of total oocytes (adjusted OR 1.27; 95 % confidence interval, 1.18, 1.38) and percentage of mature oocytes (AOR 1.10; 95 % confidence interval, 1.03, 1.17) obtained compared to GnRHa trigger alone.
  
  
  CONCLUSIONS
  Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with a significantly increased risk of severe OHSS compared to GnRH alone. However, dual trigger may be associated with a modest increase in oocyte yield, both in terms of number and maturity.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, PA, USA. kathleen.o'neill2@uphs.upenn.edu.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: O'Neill
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, PA, USA.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Senapati
authors.affiliation: School of Medecine, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
authors.forename: Ivy
authors.initials: I
authors.lastname: Maina
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, PA, USA.
authors.forename: Clarisa
authors.initials: C
authors.lastname: Gracia
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, PA, USA.
authors.forename: Anuja
authors.initials: A
authors.lastname: Dokras
mesh_terms: D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects* / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced / Q000473:pathology*; D009865:Oocytes / Q000187:drug effects / Q000473:pathology; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000473:pathology*; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone
keywords: Dual trigger; GnRHa trigger; Low-dose hCG; OHSS; Oocyte maturity