DUAL TRIGGER IMPACT ON REPRODUCTIVE OUTCOMES OF GNRH ANTAGONIST CYCLES FOR IVF: A SYSTEMATIC REVIEW AND META-ANALYSIS

Human chorionic gonadotrophin (hCG) represents the gold standard trigger of final oocyte maturation in controlled ovarian stimulation cycles. An alternative with gonadotrophin-releasing hormone agonist (GnRH-a) has been demonstrated to be effective GnRH antagonist (GnRH-ant) cycles, inducing a more physiologic LH and FSH surge, but enhancing lutheal insufficiency poorer pregnancy outcomes. Some authors suggest that dual using GnRH-a combined hCG could best choice, although it remains controversial. The aim this meta-analysis is assess efficacy compared for GnRH-ant its impact on IVF reproductive A systematic review randomized control trials (RCT) observational studies comparing clinical outcomes patients underwent cycles after plus versus alone were performed. PubMed, Embase, Cochrane Library, Web Science databases searched relevant studies. main outcome measure was rate. Secondary included number retrieved, mature, fertilized oocytes, as well top-quality embryos. Sub-analysis considering normo-responder or poor-responder separately conducted. 10 RCTs 16 included. Dual associated significantly higher rates per cycle than (normal responders [NR] odds ratio [OR] 1.84, 95% confidence interval [95CI] 1.36-2.48; poor [PR] OR 2.62, 95CI 1.52-4.53). Also, group presented retrieved oocytes (NR MD 1.32, 0.89-1.76; PR 0.38, 95 IC 0.16-0.60), mature difference means [MD] 0.93-1.71; prior high rate immature 2.95, 2.16-3.73), 1.13, 0.55-1.71; 2.45, 1.42-3.49), embryos 0.7, 0.38-1.02; 0.5-0.9; 1.36, 0.05-2.67). seems superior normal response stimulation. Compared alone, also improves fertilization rates, need cautiously considered due moderate quality evidence.