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Combined GnRH-agonist and human chorionic gonadotropin trigger improves ICSI cycle outcomes in patients with history of poor fertilization

  • Assisted Reproduction Technologies
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Abstract

Purpose

The purpose of this study was to investigate the utility of a combined GnRH-agonist (GnRH-a) and human chorionic gonadotropin (hCG) trigger in improving ICSI cycle outcomes in patients with poor fertilization history after standard hCG trigger in prior ICSI cycles.

Methods

Retrospective cohort study. Patients with a fertilization rate of <20% in at least two prior ICSI cycles who subsequently underwent another ICSI cycle with hCG trigger were compared to those who underwent another ICSI cycle with a combined GnRH-a and hCG trigger. Oocyte maturity, fertilization, clinical pregnancy, and live birth rates were compared. A multiple linear regression model was used to explore the association between combined GnRH-a and hCG trigger (vs hCG trigger alone) and fertilization rate.

Results

A total of 427 patients with mean age of 37.3 ± 1.94 years and mean baseline fertilization rate of 17.9 ± 2.03% were included, of which 318 (74.5%) and 109 (25.5%) patients underwent a subsequent ICSI cycle with hCG and combined GnRH-a and hCG trigger, respectively. The baseline parameters of the male and female partner were similar. The mean fertilization rate in the combined trigger group was 16.4% (95% CI: 7.58–25.2%) higher than the hCG trigger group, even after adjustment for confounders. Patients in the combined trigger group had higher oocyte maturity (82.1 vs 69.8%), higher clinical pregnancy (27.5 vs 5.67%), and higher live birth rates (20.2 vs 3.46%) compared to the hCG trigger group.

Conclusions

Combined GnRH-a and hCG trigger in ICSI cycles increase oocyte maturity, fertilization, clinical pregnancy, and live birth rates in patients with a history of poor fertilization after standard hCG trigger alone.

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Acknowledgements

We thank Dr. Paul J. Christos for his assistance with statistical analyses and Logan Stone for his editorial assistance.

Author information

Author notes

  1. Authors R.T.E. and N.P. have contributed equally to this work.

Authors and Affiliations

  1. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave, New York, NY, 10021, USA

    Rony T. Elias, Nigel Pereira, Lisa Artusa, Amelia G. Kelly, Monica Pasternak, Jovana P. Lekovich, Gianpiero D. Palermo & Zev Rosenwaks

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  1. Rony T. Elias
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  2. Nigel Pereira
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  3. Lisa Artusa
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  7. Gianpiero D. Palermo
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Correspondence to Rony T. Elias.

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Electronic supplementary material

Supplemental Figure 1

Comparison of luteinizing hormone levels at the start of cycle, day of trigger and day after trigger in patients receiving combined GnRH-a and hCG trigger. (GIF 2 kb)

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Elias, R.T., Pereira, N., Artusa, L. et al. Combined GnRH-agonist and human chorionic gonadotropin trigger improves ICSI cycle outcomes in patients with history of poor fertilization. J Assist Reprod Genet 34, 781–788 (2017). https://doi.org/10.1007/s10815-017-0917-3

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  • DOI: https://doi.org/10.1007/s10815-017-0917-3

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