DISCUSSION
OHSS
The results of our study validate the hypothesis that by adding a GnRH agonist to the
hCG trigger, the dual trigger does help achieve better oocyte maturation, as
evidenced by a greater number of MII oocytes retrieved in the dual trigger group. We
observed a statistically significant increase in the number of mature MII oocytes,
day-1 2PN, total number of embryos, and number of grade-1 embryos in the dual
trigger group. Consequently, the number of embryos cryopreserved was also
significantly greater in the dual trigger group.Our study included women with a normal ovarian reserve (AMH >1.2 ng/ml and AFC
between 5-25), with no history of uterine surgery. Women with diminished ovarian
reserve or at a high risk of OHSS were excluded, since these were variables
associated with adverse IVF outcomes. This was in concurrence with previous studies
by The current study is one of the few to study LH levels 12 hours after the
administration of the trigger. The prospective clinical trial by Though the clinical trial by In the current study, a significantly higher numbers of embryos were cryopreserved in
the dual trigger group than in the single trigger group (2.68±2.22
There was no significant difference in clinical pregnancy rates between the dual and
single trigger groups (21% It is of due importance to note that the dose of GnRH agonist and hCG in the dual
trigger has not been standardized and no fixed dosage of the same exists for dual
trigger (Comparison of study design, sample size, triggers and ART procedure in
different studies.In conclusion, the current study highlights the favorable outcomes associated with
triggering final oocyte maturation with the dual trigger. With the only exception of
high responders, the dual trigger is an effective strategy to improve the outcomes
of ART in women undergoing antagonist downregulated cycles. Even though our study
showed comparable clinical pregnancy rates between the two groups, the better embryo
quality and the greater number of cryopreserved embryos associated with the dual
trigger may dramatically improve cumulative live births. The strength of the study
lies in the fact that it was a randomized trial and in its strict inclusion and
exclusion criteria, which made it possible to remove all confounding variables of
adverse IVF outcomes. But due to paucity of time, and the major impact of COVID-19
on ART services, outcomes were followed to clinical pregnancy rates only.
Nevertheless, we recommend that large, robust randomized clinical trials comparing
dual trigger with standard hCG trigger be organized to follow the reproductive
outcomes of women undergoing both fresh and frozen embryo transfers in subsequent
cycles, thus comparing outcomes in terms of cumulative pregnancy rate.