P-720 A Prospective study in Poor-Responders comparing the ART-Results using Dual-Trigger (GnRH-agonist and HCG ) with conventional HCG trigger

Abstract

Study question Does use of Dual-trigger (GnRH-agonist with HCG ) improve the ART Results in Poor-Responders as compared to HCG trigger alone ? Summary answer Yes, the use of Dual-trigger (GnRH-agonist with HCG ) improve the ART-Results in Poor-Responders with diminished ovarian reserve as compared to HCG trigger alone . What is known already The population of poor ovarian reserve has grown exponentially over the years and their management of ovarian stimulation remains one of the most challenging aspects. In GnRH antagonist down-regulated IVF-ICSI cycles, dual triggering for the final oocyte maturation with GnRH-a and a reduced dose of hCG improves the ART-Results in women with diminished ovarian reserve. Further more, the benefit of less cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their IVF-ICSI Cycles treatment, thereby enhancing their better ART-Results Evidence indicates that dual triggering combines the advantages of GnRHa and hCG. Study design, size, duration This RCT included GnRH antagonist ICSI cycles from 2021-24. 62 women with diminished ovarian reserve (AMH ≤ 1.1 ng/ml and AFC ≤5) were included. The primary outcome measured was the oocyte fertilization rate, implantation rate and clinical pregnancy rate per oocyte retrieval cycle. Secondary outcome measured was embryo transfer cancellation rate and abortion rate per oocyte retrieval cycle. Participants/materials, setting, methods 62 women with diminished ovarian reserve undergoing fresh embryo transfer were included and randomly divided in two groups - Group-A (hCG trigger/control group: n = 31); and Group-B (dual trigger/study group: n = 31). Both patient groups underwent controlled ovarian stimulation using antagonist. The final oocyte maturation was triggered either by recombinant hCG (Group-A) or by a combination of recombinant hCG and GnRH-agonist (Dual trigger) (Group-B). Main results and the role of chance The dual-trigger group had significantly higher fertilization rate , higher clinical pregnancy rate as compared to the recombinant-hCG trigger group. In addition, the abortion rate and embryo transfer cancellation rate were both significantly lower in the dual trigger group. The baseline characteristics for the control and the study group were similar and there was no significant difference in the patient age, serum AMH level, and cause of infertility. The total r-FSH dose, duration of stimulation, endometrial thickness, and serum hormone profile on the day of trigger were also similar between the control and the study group. The main advantage of triggering with GnRH-a is that it induces a mid-cycle FSH surge which resembles the natural ovulatory cycle hormonal changes. Study shows that in GnRH antagonist ART cycles, dual triggering with GnRH-a and hCG could significantly improve the ART-Results in Poor-Responders . Furthermore, the benefit of lowered cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their IVF-ICSI-Cycles treatment thereby enhancing their chance of achieving a successful pregnancy as well as reducing their mental stress. Limitations, reasons for caution The main limitation of our study is the low patient number. Triggering with GnRH-a has become a significant part of contemporary ART practice, especially in high responders, oocytes donors and oncology patients. However, more RCTs are required in order to justify the use of GnRH-agonists in poor responders in ART cycles. Wider implications of the findings The main limitation of our study is the low patient number. Triggering with GnRH-a has become a significant part of contemporary ART practice, especially in high responders, oocytes donors and oncology patients. However, more larger RCTs are required in order to justify the use of GnRH-agonists in poor-ovarian-reserve patients in ART cycles. Trial registration number No