Embryo division timings and top-quality embryo rates in GnRH-Antagonist ICSI cycles: a comparison of hCG and dual trigger methods.

PURPOSE

To evaluate the impact of trigger types in Gonadotropin-releasing hormone (GnRH) antagonist IVF-ICSI cycles on embryo morphokinetics and top-quality embryo production.

METHODS

Retrospective cohort study of GnRH-antagonist IVF-ICSI cycles from July 2013 to December 2022. Embryo morphokinetics, top-quality embryo rates, and outcomes were compared between hCG and dual trigger (GnRH-agonist and hCG). Matching was based on age, BMI, and number of aspirated oocytes. Dual trigger consisted of Decapeptyl 0.2 mg and Ovitrelle 250 mcg, administered simultaneously. Embryo development was monitored with Embryoscope Time-lapse, and top-quality embryos were identified using an in-house model based on known implantation outcomes.

RESULTS

Of 1224 women, 269 matched pairs were analyzed, including 792 embryos in the dual trigger group and 758 in the hCG group. Most demographic and clinical parameters were comparable. Significant differences included higher basal FSH (8.1 ± 2.7 vs. 7.5 ± 2.5 IU/mL, P = 0.024) and total FSH dose (2991.9 ± 1048.5 vs. 2277.1 ± 1070.2, P < 0.001) in the dual trigger group. Embryo morphokinetics showed no significant differences, except for slightly longer time to fourth cleavage (t4: 40.4 ± 6.0 vs. 39.8 ± 4.5 h, P = 0.032) and synchrony of the second division (S2: 1.3 ± 2.7 vs. 1.0 ± 1.8 h, P = 0.008) in the dual trigger group. Top-quality embryo rates and clinical outcomes, including pregnancy, implantation, miscarriage, and live birth, were comparable between groups, with a later embryo transfer day in the dual trigger group (3.5 ± 1.3 vs. 3.2 ± 1.1 days, P = 0.011).

CONCLUSIONS

Dual triggering in GnRH-antagonist ICSI cycles did not improve most morphokinetic parameters, top-quality embryo rates, or clinical outcomes over hCG alone, suggesting limited benefit in general populations.