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We thank Dr. Orvieto for his interest in our recently published article [1] reporting the utility of a combined gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) ovulatory trigger in improving intracytoplasmic sperm injection (ICSI) cycle outcomes in patients with a history of poor fertilization in prior ICSI cycles with standard hCG trigger alone. The benefits of such combined or ‘dual’ triggers are being increasingly harnessed to improve the efficiency of donor oocyte-recipient cycles, elective oocyte cryopreservation, or fertility preservation prior to cancer therapy. It is also enthusing to note the increasing scope of dual triggers in challenging scenarios such as poor fertilization, abnormal follicular maturation and poor oocyte maturity [2, 3]. We are grateful for Dr. Orvieto’s timely letter that discusses additional indications for the administration of a dual trigger. Although prolongation of the time interval between the ovulatory trigger and oocyte retrieval has been described in the setting of a standard hCG trigger [4, 5], the modification of the dual trigger into a ‘double trigger’ by prolonging the time between ovulation triggering and oocyte retrieval seems very promising [6, 7]. The benefits of dual and double ovulatory triggers accrued from the work of Dr. Orvieto as well as others will continue to improve the care of couples undergoing assisted reproduction.
References
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Elias, R.T., Pereira, N. & Palermo, G.D. The benefits of dual and double ovulatory triggers in assisted reproduction. J Assist Reprod Genet 34, 1233 (2017). https://doi.org/10.1007/s10815-017-0979-2
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DOI: https://doi.org/10.1007/s10815-017-0979-2