Effect of a “Dual Trigger” Using a GnRH Agonist and hCG on the Cumulative Live-Birth Rate for Normal Responders in GnRH-Antagonist Cycles

“Dual triggering” for final oocyte maturation using a combination of a gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) can improve clinical outcomes in high responders during in vitro fertilization–intracytoplasmic sperm injection (IVF–ICSI) GnRH-antagonist cycles. However, whether this dual trigger is also beneficial to normal responders is not known. We retrospectively analyzed the data generated from 469 normal responders from 1 January to 31 December 2017. The final oocyte maturation was undertaken with a dual trigger with a GnRHa combined with hCG (n = 270) or hCG alone (n = 199). Patients were followed up for 3 years. The cumulative live-birth rate was calculated as the first live birth achieved after all cycles having an embryo transfer (cycles using fresh embryos and frozen–thawed embryos) among both groups. Women in the dual-trigger group achieved a slightly higher number of oocytes retrieved (11.24 vs. 10.24), higher number of two-pronuclear (2PN) embryos (8.37 vs. 7.67) and a higher number of embryos available (4.45 vs. 4.03). However, the cumulative live-birth rate and the all-inclusive success rate for assisted reproductive technology was similar between the two groups (54.07 vs. 59.30%). We showed that a dual trigger was not superior to a hCG-alone trigger for normal responders in GnRH-antagonist cycles in terms of the cumulative live-birth rate.

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The Effect of Dual Trigger With GnRH Agonist and hCG on Cumulative Live-Birth Rate For Normal Responders in GnRH-Antagonist Cycles

10.21203/rs.3.rs-156553/v1 ◽

2021 ◽

Author(s):

Fumei Gao ◽

Yanbin Wang ◽

Min Fu ◽

Qiuxiang Zhang ◽

Yumeng Ren ◽

...

Keyword(s):

Live Birth ◽

Oocyte Maturation ◽

Gnrh Agonist ◽

Birth Rate ◽

Gnrh Antagonist ◽

Live Birth Rate ◽

Cumulative Live Birth Rate ◽

Final Oocyte Maturation ◽

Cumulative Live Birth ◽

High Responders

Abstract It has been widely acknowledged that the dual triggering for final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) improve clinical outcomes in high responders during IVF-ICSI GnRH-antagonist cycles. However, it remains elusive whether this dual trigger is also benifical to the normal responders. The aim of this study was to investigate this issue. In the present study, we retrospectively analysed the data generated from a total of 469 normal responders from 1st January to 31st December 2017 and final oocyte maturation was performed with dual trigger with GnRH agonist combined hCG (n=270) or hCG alone (n=199). All the patients were followed up for three years. Cumulative live birth rate was calculated as the first live birth achieved after all cycles having an embryo transfer (fresh cycles as well as thawing cycles) among both groups. Subjects in the dual trigger group achieved a slightly higher number of oocytes retrieved (11.24 vs. 10.24), higher number of two-pronuclear embryo (2PN) (8.37 vs.7.67) and a higher number of embryos available (4.45 vs.4.03). But the cumulative live birth rate, an all-inclusive success rate for assisted reproductive technology, was similar between the two groups (54.07% vs.59.30%). This study showed that the dual trigger was not superior to only hCG trigger for normal responders in GnRH antagonist cycles in terms of cumulative live birth rate.

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A Premature Rise of Luteinizing Hormone Is Associated With a Reduced Cumulative Live Birth Rate in Patients ≥37 Years Old Undergoing GnRH Antagonist In Vitro Fertilization Cycles

Frontiers in Endocrinology ◽

10.3389/fendo.2021.722655 ◽

2021 ◽

Vol 12 ◽

Author(s):

Fumei Gao ◽

Yanbin Wang ◽

Dan Wu ◽

Min Fu ◽

Qiuxiang Zhang ◽

...

Keyword(s):

Luteinizing Hormone ◽

Live Birth ◽

Ovarian Stimulation ◽

Birth Rate ◽

Gnrh Antagonist ◽

Live Birth Rate ◽

Advanced Age ◽

Cumulative Live Birth Rate ◽

Cumulative Live Birth

This is a retrospective cohort study included 1021 patients underwent a flexible GnRH antagonist IVF protocol from January 2017 to December 2017 to explore the effect of a premature rise in luteinizing hormone (LH) level on the cumulative live birth rate. All patients included received the first ovarian stimulation and finished a follow-up for 3 years. A premature rise in LH was defined as an LH level >10 IU/L or >50% rise from baseline during ovarian stimulation. The cumulative live birth rate was calculated as the number of women who achieved a live birth divided by the total number of women who had either delivered a baby or had used up all their embryos received from the first stimulated cycle. In the advanced patients (≥37 years), the cumulative live birth rate was reduced in patients with a premature rise of LH (β: 0.20; 95% CI: 0.05–0.88; p=0.03), compared to patients (≥37 years) without the premature LH rise. The incidence of premature LH rise is associated with decreased rates of cumulative live birth rate in patients of advanced age (≥37 years) and aggravated the reduced potential of embryos produced by the advanced age, not the number of embryos.

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Cumulative live birth rate after up to three consecutive embryo transfer cycles in women with poor ovarian response

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2019.03349 ◽

2020 ◽

Vol 47 (2) ◽

pp. 135-139

Author(s):

Se Jeong Kim ◽

Dayong Lee ◽

Seul Ki Kim ◽

Byung Chul Jee ◽

Seok Hyun Kim

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Ovarian Response ◽

Rank Test ◽

Poor Ovarian Response ◽

Cumulative Live Birth Rate ◽

Cumulative Live Birth

Objective: In the present study, we aimed to retrospectively evaluate the cumulative live birth rate (LBR) after up to three consecutive embryo transfer (ET) cycles, either fresh or frozen, in women with expected poor ovarian response (ePOR). Methods: We selected 115 women who entered the first <i>in vitro</i> fertilization (IVF) cycle between August 2013 and July 2016. The women were divided into an ePOR group (37 women) and a non-ePOR group (78 women). All women in the ePOR group were ≥40 years old or had serum anti-Müllerian hormone levels of less than 1.1 ng/mL at the time of the first IVF cycle. Live birth outcomes were monitored until December 2017. The cumulative LBR (with both conservative and optimistic estimates) was calculated according to the serial number of ET cycles. Results: After up to three ET cycles, the overall cumulative LBR was significantly lower in the ePOR group than in the non-ePOR group (conservative estimate, 10.8% vs. 44.9%, respectively; optimistic estimate, 14.7% vs. 56.1%, respectively; log-rank test, <i>p</i>=0.003). Conclusion: Women with ePOR exhibited a lower cumulative LBR than women in the non-ePOR group, and this information should be provided to ePOR women during counseling before starting IVF.

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