Dual trigger protocol is an effective in vitro fertilization strategy in both normal and high responders without compromising pregnancy outcomes in fresh cycles

Assisted Reproduction

VOLUME 2, ISSUE 3, P314-319, SEPTEMBER 01, 2021


Rebecca K. Chung, M.D., Abigail C. Mancuso, M.D., Karen M. Summers, M.P.H., C.H.E.S., Amy E. Sparks, Ph.D., Hakan E. Duran, M.D., Rachel B. Mejia, D.O.



To study the birth rates of normal vs. high responders after dual trigger of final oocyte maturation with gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin in fresh in vitro fertilization (IVF) cycles in which ovarian stimulation was achieved by a flexible GnRH antagonist protocol.


Retrospective cohort study.


University hospital.


In women <35 years of age, 290 fresh IVF cycles using the dual trigger protocol with day 5 embryo transfers from January 2013 to July 2018 were included. Cycles excluded were those with preimplantation genetic testing, gestational carriers, donor oocytes, and fertility preservation.


IVF with dual trigger.

Main Outcome Measure(s)

Clinical pregnancy rate, live birth rate.


Comparing normal responders, defined as <30 oocytes retrieved, and high responders, defined as ≥30 oocytes retrieved, the clinical pregnancy rates (67.0% vs. 69.3%, respectively) and live birth rates (60.5% vs. 60.0%, respectively) were not significantly different. No cases of ovarian hyperstimulation syndrome were reported in either group.


Ovarian stimulation by a flexible GnRH antagonist protocol followed by dual trigger yields comparable outcomes between normal and high responders in fresh IVF cycles.