DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.

Mahmoud, Safaa Ibrahim; Rashwan, Hamsa Ahmed Maher; Fahmy, Radwa Mohamed; Tolba, Al Moataz Bellah Mohamed; El-Naggar, Ramy Mohamed

doi:10.21608/egyfs.2025.409775

DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.

Document Type : Original Article

Authors

¹ Assistant professor of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt

² Professor of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt

³ Assistant lecturer of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt

⁴ Lecturer of obstetrics and gynecology, faculty of medicine, Tanta University, Tanta, Egypt

10.21608/egyfs.2025.409775

Abstract

Background and aim: Dual triggering, which combines a gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG), has been suggested to enhance outcomes in poor ovarian responders undergoing infertility treatment. This study aimed to compare the efﬁcacy of dual trigger versus HCG trigger in improving assisted reproductive technology (ART) outcomes in poor responders using a protocol of GnRH antagonist.
Methods: A prospective clinical randomized trial was conducted at Cairo University from June 2020 to March 2021, involving 86 poor responders. The study dual group (n=43) obtained a dual trigger of 5000 units of HCG plus triptorelin 0.2 mg and, whereas the other group (n=43) was given a conventional HCG trigger. Primary outcomes included the number of retrieved oocytes, mature oocytes (MII), obtained embryos, and fertilization rate.
Results: The study group exhibited signiﬁcantly higher numbers of retrieved oocytes, MII oocytes, fertilization rate, obtained embryos, and embryos transferred compared to the control group (P value < 0.05). Although the implantation rate and chemical pregnancy rate were higher in the study group, the differences were not statistically signiﬁcant (P value 0.482 and 0.492, respectively).
Conclusion: dual triggering with HCG and GnRH agonist may enhance ovulation triggering and reproductive outcomes in poor responders undergoing antagonist ICSI cycles, leading to increased numbers of retrieved oocytes, MII oocytes, obtained embryos, and fertilization rate. However, the impact on pregnancy and implantation rates was not statistically signiﬁcant.

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