Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, 40201, Taichung, Taiwan (R.O.C.).
School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., 402, Taichung, Taiwan (R.O.C.).
J Assist Reprod Genet. 2023 Sep;40(9):2063-2077. doi: 10.1007/s10815-023-02888-8. Epub 2023 Jul 19.
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.
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).
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]).
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.
After dual trigger, delaying ET due to the concern of endometrial receptivity might not be needed.
本研究旨在评估在体外受精 (IVF) 的 GnRH 拮抗剂方案中使用促性腺激素释放激素激动剂 (GnRHa) 和人绒毛膜促性腺激素 (hCG) 的“双重触发”方法是否比单独使用 hCG 触发方法能提高妊娠结局。先前的荟萃分析并没有提供足够的证据支持双重触发优于 hCG 触发在新鲜或冷冻胚胎移植周期中的作用。因此，进行了系统评价和随机临床试验的荟萃分析，以全面评估双重触发对新鲜或冷冻胚胎移植周期妊娠结局的影响。
进行了系统评价和随机对照试验 (RCT) 的荟萃分析。我们使用搜索词在 Medline 和 Embase 数据库中搜索了截至 2023 年的文章：“双重触发”、“GnRHa”、“hCG”、“IVF”。纳入比较双重触发与 hCG 触发的随机对照试验。主要结局是每个周期的活产率 (LBR)。次要结局是每个周期的取卵数、成熟卵母细胞数、着床率、生化妊娠率、临床妊娠率、流产率和卵巢过度刺激综合征 (OHSS) 率。我们比较了双重触发和 hCG 触发组的卵母细胞成熟和妊娠结局。在接受新鲜胚胎移植 (ET) 和冷冻解冻胚胎移植的患者中，我们还进行了亚组分析，以评估双重触发是否可以提高临床妊娠率 (CPR)。
我们纳入了 10 项随机研究，其中双重触发组有 825 名参与者，hCG 触发组有 813 名参与者。与 hCG 触发相比，双重触发与每个周期的 LBR 显著增加相关（优势比[OR] = 1.61[1.16, 2.25]）、取卵数（平均差值[MD] = 1.05[0.43, 1.68]）、成熟卵母细胞数（MD = 0.82[0.84, 1.16]）和 CPR（OR = 1.48[1.08, 2.01]）。亚组分析显示，在接受新鲜 ET 的患者中，双重触发与 CPR 显著增加相关（OR = 1.68[1.14, 2.48]）。相比之下，双重触发与冷冻解冻胚胎移植患者的 CPR 增加无关（OR = 1.15[0.64, 2.08]）。
与 hCG 触发相比，双重触发在体外受精中与更高的取卵数、成熟卵母细胞数、CPR 和 LBR 相关。与冷冻解冻胚胎移植相比，新鲜 ET 周期的有益效果可能与子宫内膜容受性增加有关。
在双重触发后，由于担心子宫内膜容受性，可能不需要延迟 ET。
