DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.
Mahmoud, S., Rashwan, H., Fahmy, R., Tolba, A., El-Naggar, R. (2025). DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.. EKB Journal Management System, 29(1), 116-124. doi: 10.21608/egyfs.2025.409775
Safaa Ibrahim Mahmoud; Hamsa Ahmed Maher Rashwan; Radwa Mohamed Fahmy; Al Moataz Bellah Mohamed Tolba; Ramy Mohamed El-Naggar. "DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.". EKB Journal Management System, 29, 1, 2025, 116-124. doi: 10.21608/egyfs.2025.409775
Mahmoud, S., Rashwan, H., Fahmy, R., Tolba, A., El-Naggar, R. (2025). 'DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.', EKB Journal Management System, 29(1), pp. 116-124. doi: 10.21608/egyfs.2025.409775
Mahmoud, S., Rashwan, H., Fahmy, R., Tolba, A., El-Naggar, R. DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.. EKB Journal Management System, 2025; 29(1): 116-124. doi: 10.21608/egyfs.2025.409775

DUAL TRIGGER (GNRH AGONIST + HCG) VERSUS HCG TRIGGER in IMPROVING ART OUTCOMES IN POOR RESPONDERS UNDERGOING ANTAGONIST PROTOCOL.

The Egyptian Journal of Fertility and Sterility
Volume 29, Issue 1 - Serial Number 11106352, January 2025, Pages 116-124    PDF (263.49 K)
Document Type: Original Article
DOI: 10.21608/egyfs.2025.409775
Authors
Safaa Ibrahim Mahmoud* 1; Hamsa Ahmed Maher Rashwan2; Radwa Mohamed Fahmy2; Al Moataz Bellah Mohamed Tolba3; Ramy Mohamed El-Naggar4
1Assistant professor of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
2Professor of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
3Assistant lecturer of obstetrics and gynecology, faculty of medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
4Lecturer of obstetrics and gynecology, faculty of medicine, Tanta University, Tanta, Egypt
Abstract
Background and aim: Dual triggering, which combines a gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG), has been suggested to enhance outcomes in poor ovarian responders undergoing infertility treatment. This study aimed to compare the efficacy of dual trigger versus HCG trigger in improving assisted reproductive technology (ART) outcomes in poor responders using a protocol of GnRH antagonist.  
Methods: A prospective clinical randomized trial was conducted at Cairo University from June 2020 to March 2021, involving 86 poor responders. The study dual group (n=43) obtained a dual trigger of 5000 units of HCG plus triptorelin 0.2 mg and, whereas the other group (n=43) was given a conventional HCG trigger. Primary outcomes included the number of retrieved oocytes, mature oocytes (MII), obtained embryos, and fertilization rate.  
Results: The study group exhibited significantly higher numbers of retrieved oocytes, MII oocytes, fertilization rate, obtained embryos, and embryos transferred compared to the control group (P value < 0.05). Although the implantation rate and chemical pregnancy rate were higher in the study group, the differences were not statistically significant (P value 0.482 and 0.492, respectively). 
Conclusion:  dual triggering with HCG and GnRH agonist may enhance ovulation triggering and reproductive outcomes in poor responders undergoing antagonist ICSI cycles, leading to increased numbers of retrieved oocytes, MII oocytes, obtained embryos, and fertilization rate. However, the impact on pregnancy and implantation rates was not statistically significant. 

Keywords
Poor responders; Dual trigger; Antagonist cycles; ICSI protocols
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