Comparing the effect of three trigger methods (human HCG, combination of recombinant HCG with GnRH agonist, and double recombinant HCG) on the fertility outcome of patients with poor ovarian response in ovulation stimulation cycle (IVF/ICSI)

Abstract

Aim: The aim of this study is comparing the effect of three trigger methods (human HCG, combination of recombinant HCG with GnRH agonist, and double recombinant HCG) on the fertility outcome of patients with in poor ovarian response in ovulation stimulation cycle (IVF/ICSI). Methods: In this double-blind randomized clinical trial study, 158 patients with low ovarian reserve were divided to three groups: Group 1: Two doses of recombinant HCG (Ovitrelle) at a dose of 250 mu g at 12 hour intervals, Group 2: HCG trigger (KARMA) alone at a dose of 10,000 units, and Group 3: 250 mu g of recombinant HCG+ GNRH agonist. Collected data includes age, BMI, AMH, type of transferred embryo (Fresh or Freez), number of embryos, and results of pregnancy (clinical pregnancy rate/ongoing pregnancy rate/ implantation rate). Three groups is statistically similar in terms of age and BMI, AMH, and AFC. Results: In groups 1 and 3, the number of oocytes, the number of M2 oocytes and the number of 2PN embryos was higher than group 2 after ovulation. The percentage of empty follicle syndrome was low in the two groups 1 and 3. Three groups had no significant difference in term of fertilization rate, the number of embryos A, B, and C, chemical pregnancy, clinical pregnancy, ongoing pregnancy, and implantation rate. Conclusion: Dual trigger treatment with recombinant hCG and GNRH agonist and double recombinant hCG can improve fertility outcome patients with poor response in ovulation stimulation cycle. However, there were no significant differences among three groups regarding pregnancy results.