Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist

Basal luteinizing hormone was useful predictor of the suboptimal response to gonadotropin-releasing hormone agonist trigger. Administrating 1,000 IU human chorionic gonadotropin for final oocyte maturation could improve the oocyte retrieval rate of gonadotropin-releasing hormone agonist suboptimal responders.

Volume 106, Issue 6, Pages 1356-1362


Xuefeng Lu, Ph.D., Qingqing Hong, M.D., LiHua Sun, M.D., Qiuju Chen, Ph.D., Yonglun Fu, M.D., AiAi, M.D., Qifeng Lyu, Ph.D., Yanping Kuang, M.D., Ph.D.



To identify the risk factors for suboptimal response to GnRH agonist (GnRH-a) trigger and evaluate the effect of hCG on the outcome of patients with suboptimal response to GnRH-a.


A retrospective data analysis.


A tertiary-care academic medical center.


A total of 8,092 women undergoing 8,970 IVF/intracytoplasmic sperm injection (ICSI) treatment cycles.


All women underwent hMG + medroxyprogesterone acetate (MPA)/P treatment cycles during IVF/ICSI, which were triggered using a GnRH-a alone or in combination with hCG (1,000, 2,000, or 5,000 IU). Viable embryos were cryopreserved for later transfer.

Main Outcome Measure(s)

The rates of oocyte retrieval, mature oocytes, fertilization, and the number of oocytes retrieved, mature oocytes, and embryos frozen.


In total, 2.71% (243/8,970) of patients exhibited a suboptimal response to GnRH-a. The suboptimal responders (LH ≤15 mIU/mL) had a significantly lower oocyte retrieval rate (48.16% vs. 68.26%), fewer mature oocytes (4.10 vs. 8.29), and fewer frozen embryos (2.32 vs. 3.54) than the appropriate responders. Basal LH levels served as the single most valuable marker for differentiating suboptimal responders with the areas under the receiver operating curve of 0.805. Administering dual trigger (GnRH-a and hCG 1,000, 2,000, 5,000 IU) significantly increased oocyte retrieval rates (60.04% vs. 48.16%; 68.13% vs. 48.16%; and 65.76% vs. 48.16%, respectively) in patients with a suboptimal response.


Basal LH level was useful predictor of the suboptimal response to GnRH-a trigger. Administrating dual trigger including 1,000 IU hCG for final oocyte maturation could improve the oocytes retrieval rate of GnRH-a suboptimal responder.

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Go to the profile of Micah J Hill
over 5 years ago
The challenge in this study is in the confounding variables that may effect oocyte recovery rate and were they controlled for. For example, it is clear from the results that patients with more follicles were likely to not get hCG co-trigger. And the fewer follicles a patient had, they were more likely to get increasing dosage of hCG from 1,000 to 2,000 to 5,000. Clinically this makes sense, the more OHSS risk a patient was at, the more likely they would not have any hCG co trigger given. The problem with this is there is published data showing that the more follicles a patient has, the oocyte recovery rate drops per follicle. In other words, a patient with 5 follicles is likely to have a higher recovery rate than a patient with 50 follicles. So, is hCG co-trigger leading to the higher recovery rate? Or is it that patients who had hCG also happened to have fewer follicles and therefore had a higher recovery rate? Unfortunately this potentially substantial confounder is not accounted for. Could the authors analyze their data and account for this? If the number of follicles is controlled for, was hCG trigger still associated with a higher oocyte recovery rate?