title: Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist.
abstract: OBJECTIVE
  To identify the risk factors for suboptimal response to GnRH agonist (GnRH-a) trigger and evaluate the effect of hCG on the outcome of patients with suboptimal response to GnRH-a.
  
  
  METHODS
  A retrospective data analysis.
  
  
  METHODS
  A tertiary-care academic medical center.
  
  
  METHODS
  A total of 8,092 women undergoing 8,970 IVF/intracytoplasmic sperm injection (ICSI) treatment cycles.
  
  
  METHODS
  All women underwent hMG + medroxyprogesterone acetate (MPA)/P treatment cycles during IVF/ICSI, which were triggered using a GnRH-a alone or in combination with hCG (1,000, 2,000, or 5,000 IU). Viable embryos were cryopreserved for later transfer.
  
  
  METHODS
  The rates of oocyte retrieval, mature oocytes, fertilization, and the number of oocytes retrieved, mature oocytes, and embryos frozen.
  
  
  RESULTS
  In total, 2.71% (243/8,970) of patients exhibited a suboptimal response to GnRH-a. The suboptimal responders (LH ≤15 mIU/mL) had a significantly lower oocyte retrieval rate (48.16% vs. 68.26%), fewer mature oocytes (4.10 vs. 8.29), and fewer frozen embryos (2.32 vs. 3.54) than the appropriate responders. Basal LH levels served as the single most valuable marker for differentiating suboptimal responders with the areas under the receiver operating curve of 0.805. Administering dual trigger (GnRH-a and hCG 1,000, 2,000, 5,000 IU) significantly increased oocyte retrieval rates (60.04% vs. 48.16%; 68.13% vs. 48.16%; and 65.76% vs. 48.16%, respectively) in patients with a suboptimal response.
  
  
  CONCLUSIONS
  Basal LH level was useful predictor of the suboptimal response to GnRH-a trigger. Administrating dual trigger including 1,000 IU hCG for final oocyte maturation could improve the oocytes retrieval rate of GnRH-a suboptimal responder.
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Hong
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: LiHua
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Qiuju
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Yonglun
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Ai
authors.initials: A
authors.lastname: Ai
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Qifeng
authors.initials: Q
authors.lastname: Lyu
authors.affiliation: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. Electronic address: kuangyanp@126.com.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Kuang
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000008:administration & dosage* / Q000009:adverse effects; D015925:Cryopreservation; D004359:Drug Therapy, Combination; D005260:Female; D005298:Fertility / Q000187:drug effects; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007986:Luteinizing Hormone / Q000097:blood; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D008596:Menotropins / Q000008:administration & dosage* / Q000009:adverse effects; D054315:Oocyte Retrieval; D009865:Oocytes / Q000187:drug effects* / Q000378:metabolism; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011374:Progesterone / Q000008:administration & dosage* / Q000009:adverse effects; D012372:ROC Curve; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D008596:Menotropins; D007986:Luteinizing Hormone; D017258:Medroxyprogesterone Acetate
keywords: GnRH-a; IVF; Infertility; dual trigger; hCG