Dual Trigger with Gonadotropin Releasing Hormone Agonist and Human  Chorionic Gonadotropin of Fresh Autologous Cycles in High Responders: A Systematic Review

Andreas A  Vyrides; Essam El  Mahdi; Demetris  Lamnisos; Konstantinos  Giannakou

doi:10.18502/jri.v23i1.8446

Andreas A Vyrides Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
Essam El Mahdi Department of Obstetrics and Gynaecology, Newham University Hospital NHS Trust, London, United Kingdom
Demetris Lamnisos Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
Konstantinos Giannakou Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus

DOI: https://doi.org/10.18502/jri.v23i1.8446

Keywords: Dual trigger, Fresh autologous cycles, Gonadotropin releasing hormone (GnRH), Ovarian hyperstimulation syndrome (OHSS), Systematic review.

Abstract

Background: The purpose of the current study was to investigate the effect of coadministration of human chorionic gonadotropin (hCG) with gonadotropin releasing hormone agonist (GnRH-a) trigger (dual trigger) in high responders for fresh autologous cycles in order to investigate the pregnancy outcomes and rates of ovarian hyperstimulation syndrome (OHSS) in comparison to GnRH-a trigger alone.

Methods: A systematic search was performed in PubMed and Ovid MEDLINE from inception through February 2020. The included materials were case-control, cohort and, cross-sectional studies as well as clinical trials in which the outcomes of dual trigger with GnRH-a were compared for final oocyte maturation in high responders undergoing GnRH-ant cycles.

Results: Five retrospective studies were included for this review. Three of the studies showed that the use of dual trigger versus GnRH-a trigger resulted in no statistically significant difference in rates of OHSS while achieving a statistically significant difference in favor of the dual trigger group in ongoing pregnancy rates, early pregnancy loss, and fertilization rates.

Conclusion: Currently, there is insufficient evidence to support improved clinical pregnancy rate, fertilization rate, live birth rate, and early pregnancy loss rate by the use of dual trigger versus GnRH-a trigger. Larger double-blind clinical studies are required to properly evaluate the efficacy of this protocol for use in high responders.