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Effect of GnRH agonist trigger with or without low-dose hCG on reproductive outcomes for PCOS women with freeze-all strategy: a propensity score matching study

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
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Abstract

Purpose

This study aimed to compare the effect of gonadotropin-releasing hormone agonist (GnRHa) trigger alone versus dual trigger comprising GnRHa and low-dose human chorionic gonadotropin (hCG) on reproductive outcomes in patients with polycystic ovary syndrome (PCOS) who received the freeze-all strategy.

Methods

A total of 615 cycles were included in this retrospective cohort study. Propensity score matching (PSM) was performed to control potential confounding factors between GnRHa-trigger group (0.2 mg GnRHa) and dual-trigger group (0.2 mg GnRHa plus 1000/2000 IU hCG) in a 1:1 ratio. Multivariate logistic regression was applied to estimate the association between trigger methods and reproductive outcomes.

Results

After PSM, patients with dual trigger (n = 176) had more oocytes retrieved, mature oocytes, and 2PN embryos compared to that with GnRHa trigger alone. However, the oocytes maturation rate, normal fertilization rate, and frozen embryos between the two groups were not statistically different. The incidence of ovarian hyperstimulation syndrome (OHSS) (14.8% vs. 2.8%, P < 0.001) and moderate/severe OHSS (11.4% vs. 1.7%, P < 0.001) were significantly higher in dual-trigger group than in GnRHa-alone group. Logistic regression analysis showed the adjusted odds ratio of dual trigger was 5.971 (95% confidence interval 2.201–16.198, P < 0.001) for OHSS. The pregnancy and single neonatal outcomes were comparable between the two groups (P > 0.05).

Conclusion

For PCOS women with freeze-all strategy, GnRHa trigger alone decreased the risk of OHSS without damaging oocyte maturation and achieved satisfactory pregnancy outcomes.

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Data availability

The datasets used and analyzed during the current study are available from corresponding author on reasonable request.

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Funding

This work was supported by the National Health Commission Key Laboratory of Birth Defects and Reproductive Health (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute) (grant number:2021yjy-kfkt-0008) and the Platform of Chongqing Yidu Cloud (grant number: ZHYX202127).

Author information

Author notes

  1. Qiaofeng Wang and Qi Wan have contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China

    Qiaofeng Wang, Zhaohui Zhong & Xiaojun Tang

  2. Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China

    Qiaofeng Wang

  3. Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China

    Yubin Ding

  4. Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, College of Medical Informatics, Chongqing Medical University, Chongqing, China

    Kexue Pu

  5. Department of Reproductive Center, Chengdu Jinjiang Hospital for Women’s and Children’s Health, Chengdu, China

    Xuejiao Wang & Yuling Hu

  6. Department of Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Tian Li

  7. Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China

    Yubin Ding

  8. Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China

    Qi Wan

  9. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China

    Qi Wan

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  1. Qiaofeng Wang
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Contributions

XT and YD: Conceptualization; XW and YH: Data curation. TL: Supervision; QW: Formal analysis; QW and QW: Writing—original draft; ZZ and KP: Writing—review and editing.

Corresponding authors

Correspondence to Yubin Ding or Xiaojun Tang.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethics approval

The study was performed in accordance with the ethical standards of the Declaration of Helsinki (1964) and its subsequent amendments. The study protocol involved human participants were approved by the Ethics Committee of Chongqing Medical University (number: 2021060).

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Due to the retrospective nature, written informed consent was waived by the Ethics Committee of Chongqing Medical University.

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Wang, Q., Wan, Q., Li, T. et al. Effect of GnRH agonist trigger with or without low-dose hCG on reproductive outcomes for PCOS women with freeze-all strategy: a propensity score matching study. Arch Gynecol Obstet 309, 679–688 (2024). https://doi.org/10.1007/s00404-023-07285-1

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