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Dual trigger improves the pregnancy rate in fresh in vitro fertilization (IVF) cycles compared with the human chorionic gonadotropin (hCG) trigger: a systematic review and meta-analysis of randomized trials

  • Assisted Reproduction Technologies
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Abstract

Propose

The purpose of this study was to assess whether the implementation of a "dual trigger" approach, utilizing gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) in the GnRH antagonist protocol for in vitro fertilization (IVF), leads to improved pregnancy outcomes compared to the conventional hCG trigger alone. Previous meta-analyses have not provided sufficient evidence to support the superiority of the dual trigger over the hCG trigger in fresh or frozen embryo transfer cycles. Thus, a systematic review and meta-analysis of randomized trials were conducted to provide a comprehensive evaluation of the impact of the dual trigger on pregnancy outcomes in fresh or frozen embryo transfer cycles.

Method

A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted. We searched the Medline and Embase databases for articles up to 2023 by using search terms: “dual trigger,” “GnRHa,” “hCG,” “IVF.” Eligible RCTs comparing the dual trigger with the hCG trigger were included. The primary outcome was the live birth rate (LBR) per cycle. The secondary outcomes were the number of oocytes retrieved, number of mature oocytes retrieved, implantation rate, biochemical pregnancy rate, CPR, miscarriage rate and ovarian hyperstimulation syndrome (OHSS) rate per started cycle We compared the oocyte maturation and pregnancy outcomes in the dual trigger and hCG trigger groups. In patients undergoing fresh embryo transfer (ET) and frozen–thawed ET, we also conducted a subgroup analysis to evaluate whether dual trigger improves the clinical pregnancy rate (CPR).

Results

We included 10 randomised studies, with 825 participants in the dual trigger group and 813 in the hCG trigger group.

Compared with the hCG trigger, dual trigger was associated with a significant increase in the LBR per cycle (odds ratio (OR) = 1.61[1.16, 2.25]), number of oocytes retrieved (mean difference [MD] = 1.05 [0.43, 1.68]), number of mature oocytes retrieved (MD = 0.82 [0. 84, 1.16]), and CPR (OR = 1.48 [1.08, 2.01]). Subgroup analyses revealed that dual trigger was associated with a significantly increased CPR in patients who received fresh ET (OR = 1.68 [1.14, 2.48]). By contrast, the dual trigger was not associated with an increased CPR in the patient group with frozen–thawed ET (OR = 1.15 [0.64, 2.08]).

Conclusion

The dual trigger was associated with a significantly higher number of retrieved oocytes, number of mature oocytes, CPR, and LBR in IVF than the hCG trigger. The beneficial effect for fresh ET cycles compared with frozen–thawed ET might be associated with increased endometrial receptivity.

Relevance

After dual trigger, delaying ET due to the concern of endometrial receptivity might not be needed.

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Data availability

All data analyzed in this study are included in this present manuscript.

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Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

There was no financial or non-financial support for this study.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, 40201, Taichung, Taiwan (R.O.C.)

    Li-Hsin Hsia, Tsung-Hsien Lee, Yu-Hsuan Lin, Yun-Yao Huang, Hao-Jung Chang & Yung-Liang Liu

  2. School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., 402, Taichung, Taiwan (R.O.C.)

    Li-Hsin Hsia, Tsung-Hsien Lee, Yu-Hsuan Lin, Yun-Yao Huang, Hao-Jung Chang & Yung-Liang Liu

  3. Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., 402, Taichung City, Taiwan (R.O.C.)

    Tsung-Hsien Lee & Yun-Yao Huang

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Contributions

THL and YLL designed and executed the study. LHH and YHL reviewed the literature, extracted the data and assessed the included studies' quality. LHH analyzed the data and wrote the manuscript. YYH and HJC took part in critical discussions. All authors scrutinised and revised the manuscript.

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Correspondence to Yung-Liang Liu.

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Hsia, LH., Lee, TH., Lin, YH. et al. Dual trigger improves the pregnancy rate in fresh in vitro fertilization (IVF) cycles compared with the human chorionic gonadotropin (hCG) trigger: a systematic review and meta-analysis of randomized trials. J Assist Reprod Genet 40, 2063–2077 (2023). https://doi.org/10.1007/s10815-023-02888-8

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  • DOI: https://doi.org/10.1007/s10815-023-02888-8

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