Journal Club: Dual Trigger in IVF- A SWOT Analysis
Written By : Dr. Garima Soni
Written By : Dr. Nandita Mohan
Published On 2025-03-31 02:45 GMT | Update On 2025-03-31 07:20 GMT
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A recent review article published in the Fertility Science Research journal published by Scientific Scholar.
The gold standard agent for inducing final oocyte maturation and resumption of meiosis in in vitro fertilisation (IVF) has historically been human chorionic gonadotropin (hCG), which acts as a surrogate for the physiological spontaneous luteinising hormone (LH) surge. Gonadotrophic releasing hormone (GnRH) agonists (GnRHa) were introduced as an alternative trigger in GnRH antagonist cycles, specifically with the advantage of a reduced risk of ovarian hyperstimulation syndrome.
However, the use of GnRH agonist trigger alone is associated with poor corpus luteum development, causing impaired endometrial receptivity and a reduced chance of successful implantation. Subsequently, A combination of a bolus of GnRHa and hCG (dual trigger) was proposed to improve IVF cycle outcomes, especially in poor and normo-responder patients.
Different studies with significant heterogeneity have reported conflicting data about the effect of this trigger combination on various outcome parameters.
Hence, the aim of the SWOT analysis is to summarise the currently available evidence of dual trigger use for final oocyte maturation and trigger in normal and poor responder patients in comparison to the standard hCG trigger.
Clinical evidence now supports the value of dual trigger where there has been a previous low proportion of mature eggs or where there is a suboptimal LH response to GnRHa alone. In poor responders, dual triggers could be considered as an effective first line.
Dual trigger allows for comparable outcomes in normal and high responders, allowing the possibility of fresh embryo transfer with good clinical pregnancy and live birth rates while minimising OHSS risk.
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