title: Evaluation of dual trigger with gonadotropin-releasing hormone agonist and human chorionic gonadotropin in improving oocyte maturity rates: A prospective randomized study.
abstract: BACKGROUND
  Mature oocytes are prerequisite for achieving the process of in vitro fertilization. Human chorionic gonadotropin (hCG) is the standard trigger used for stimulating ovulation but is associated with ovarian hyperstimulation syndrome (OHSS). Gonadotropin-releasing hormone agonist trigger achieves oocyte maturation and lowers the incidence of OHSS, but it has limitations of higher pregnancy loss rate and miscarriage rates. Coadministration of both hormones is found to improve the pregnancy rates and the number of mature oocytes retrieved. We aimed to assess if the dual trigger is better than the conventional hCG in triggering oocyte maturation.
  
  
  METHODS
  The study included 76 female patients aged 24-43 years who were randomly divided into two groups with 38 patients in each arm. The study included patients with antimullerian hormone (AMH) <4 ng/ml, antral follicle counts (AFCs)/ovary <12. The study excluded high responders-AMH >4 ng/ml and AFC/ovary >12 to avoid OHSS risk with hCG trigger.
  
  
  RESULTS
  The study showed statistically insignificant differences between dual group versus hCG group in terms of the number of oocytes retrieved (10.0 ± 5.6 vs. 8.7 ± 5.0; P = 0.2816), the number of mature oocytes recovered (8.4 ± 5.0 vs. 7.2 ± 4.0; P = 0.2588), fertilization rate (5.9 ± 4.2 vs. 5.6 ± 3.3; P = 0.7390), and the number of usable embryos on day 3 (4.0 ± 3.0 vs. 4.0 ± 2.4; P = 0.8991).
  
  
  CONCLUSIONS
  The dual trigger is equivalent to hCG in triggering oocyte maturation.
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Nalini
authors.initials: N
authors.lastname: Mahajan
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Puneet Rana
authors.initials: PR
authors.lastname: Arora
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Shalu
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Kumkum
authors.initials: K
authors.lastname: Rani
authors.affiliation: Department of Reproductive Medicine, Nova IVI Fertility, New Delhi, India.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Naidu
keywords: Dual trigger; gonadotropin-releasing hormone agonist trigger; oocyte maturation