Wang Tingting, Ren Jinxin, Qi Zhaokang, Li Xuanang, Xiang Shan, Zhao Shuai, Yu Yi, Lian Fang, Zhao Yuewen
The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Reproduction and Genetics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
Front Endocrinol (Lausanne). 2025 May 28;16:1580610. doi: 10.3389/fendo.2025.1580610. eCollection 2025.
This study was designed to evaluate the effects of dual trigger (GnRH agonist and hCG) compared with hCG trigger alone on oocyte quality, embryo development, and pregnancy outcomes in elderly women (aged≥35 years) who underwent IVF treatment with an antagonist stimulation protocol, aiming to identify the more optimal triggering strategy.
This retrospective cohort study analyzed 449 elderly infertile women (≥35 years) who underwent antagonist stimulation protocols, including 236 patients in the hCG trigger group and 213 patients in the dual trigger group. The study compares the age, gravidity, parity, body mass index (BMI),anti-Müllerian hormone (AMH),gonadotropin (Gn) days, Gn dosage, trigger day luteinizing hormone (LH), trigger day estradiol (E2), trigger day progesterone (P), number of follicles ≥14mm on trigger day, number of oocytes retrieved, two pronuclei (2PN) fertilization rate, cleavage-stage embryo number, blastocyst number, embryo implantation rate (IR), clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate between the two groups. Multivariate logistic regression was used to analyze the influencing factors of CPR in patients.
There were no significant differences in baseline and cycle data between the two groups. In terms of oocyte and embryo outcomes, the number of oocytes retrieved (P=0.018), 2PN fertilization rate (P=0.046), and cleavage-stage embryo number (P=0.032) were significantly higher in the dual trigger group than in the hCG trigger group. There was no significant difference in the number of blastocysts obtained in the cycles of the two groups (P=0.689). In terms of pregnancy outcomes, the CPR per embryo transfer (ET) cycle (P=0.010),the CPR per frozen embryo transfer (FET) cycle (P=0.011), total embryo IR (P<0.001), total CPR (P<0.001), CPR per patient (P=0.003), total LBR (P<0.001), and LBR per patient (P=0.001) were all significantly higher in the dual trigger group than in the hCG trigger group. There was no significant difference in the miscarriage rate between the two groups (P=0.841). No cases of ovarian hyperstimulation syndrome (OHSS) occurred in either group.
For elderly women undergoing antagonist stimulation protocols, the use of dual trigger, is more effective than hCG trigger alone in improving oocyte quality, embryo outcomes, and pregnancy outcomes.
本研究旨在评估在接受拮抗剂刺激方案进行体外受精治疗的老年女性（年龄≥35岁）中，与单独使用人绒毛膜促性腺激素（hCG）触发相比，双重触发（促性腺激素释放激素激动剂和hCG）对卵母细胞质量、胚胎发育和妊娠结局的影响，以确定更优的触发策略。
这项回顾性队列研究分析了449名接受拮抗剂刺激方案的老年不孕女性（≥35岁），其中hCG触发组236例，双重触发组213例。研究比较了两组患者的年龄、孕次、产次、体重指数（BMI）、抗苗勒管激素（AMH）、促性腺激素（Gn）使用天数、Gn剂量、触发日黄体生成素（LH）、触发日雌二醇（E2）、触发日孕酮（P）、触发日直径≥14mm的卵泡数量、取卵数、双原核（2PN）受精率、卵裂期胚胎数、囊胚数、胚胎着床率（IR）、临床妊娠率（CPR）、活产率（LBR）和流产率。采用多因素logistic回归分析患者CPR的影响因素。
两组患者的基线和周期数据无显著差异。在卵母细胞和胚胎结局方面，双重触发组的取卵数（P=0.018）、2PN受精率（P=0.046）和卵裂期胚胎数（P=0.032）显著高于hCG触发组。两组周期获得的囊胚数无显著差异（P=0.689）。在妊娠结局方面，双重触发组每个胚胎移植（ET）周期的CPR（P=0.010）、每个冻融胚胎移植（FET）周期的CPR（P=0.011）、总胚胎IR（P<0.001）、总CPR（P<0.001）、每个患者的CPR（P=0.003）、总LBR（P<0.001）和每个患者的LBR（P=0.001）均显著高于hCG触发组。两组的流产率无显著差异（P=0.841）。两组均未发生卵巢过度刺激综合征（OHSS）病例。
对于接受拮抗剂刺激方案的老年女性，双重触发在改善卵母细胞质量、胚胎结局和妊娠结局方面比单独使用hCG触发更有效。
