IVF/ICSI outcomes in women of age 40 years and older who underwent Dual Trigger: A retrospective cohort study

INTRODUCTION: Female age is the critical factor determining the success in assisted re-productive technology cycles. The objective of this study was to observe the impact of using dual trigger (gonadotropin-releasing hormone [GnRH] agonists and recombinant human chorionic gonadotropin (r-hCG)] for ovulation induction on in vitro fertilization (IVF)/Intracytoplasmic sperm injection outcomes of women with advanced age (40 or above).
METHODS: This retrospective cohort study was conducted on 408 patients aged 40 years or older. Only the first cycles of the patients were implicated in the study. Flexible GnRH antagonist protocol was used for ovarian stimulation in all patients. Ovulation was triggered when at least two follicles reached a size of 17 mm or more. The study group included 67 cycles that applied dual trigger. The control group consisted of 341 cases in which final oocyte maturation was triggered by hCG alone. In addition to the basic characteristics and cycle parameters of the cases, pregnancy and live birth rates (LBR) of both groups were compared.
RESULTS: Statistically, there was no prominent difference in terms of average female age, duration of infertility, duration of stimulation, amount of gonadotrophin used, cycle cancellation rate, total oocyte rate, total MII oocyte rate, 2PN rate, fertilization rate, embryo utilization rate (usable embryo/2PN), and number of transferable embryos in dual trigger and hCG only groups. Oocyte maturation rate (Number of MII oocytes/total number of oocytes) was observed to be higher in study group. Clinical pregnancy rates and LBRs were the same in both groups.
DISCUSSION AND CONCLUSION: In women aged 40 years and older, dual trigger did not show a significant increase in the oocyte maturation, clinical pregnancy, and LBRs according to hCG-only trigger patients.