Journal Club: Dual Trigger in IVF- A SWOT Analysis - Video
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Overview
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.
Speakers
Dr. Garima Soni
BDS, MDS(orthodontics)
Dr. Garima Soni holds a BDS (Bachelor of Dental Surgery) from Government Dental College, Raipur, Chhattisgarh, and an MDS (Master of Dental Surgery) specializing in Orthodontics and Dentofacial Orthopedics from Maitri College of Dentistry and Research Centre. At medical dialogues she focuses on dental news and dental and medical fact checks against medical/dental mis/disinformation
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751