GnRH agonist and hCG (dual trigger) versus hCG trigger for final follicular maturation: a double-blinded, randomized controlled study
GnRH agonist and hCG (dual trigger) versus hCG trigger for final follicular maturation: a double-blinded, randomized controlled study
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DOI：
10.1093/humrep/deaa107
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发表时间：
2020-07-01
影响因子：
6.1
通讯作者：
Casper, R. F.
中科院分区：
文献类型：
--
作者：
Haas, J.;Bassil, R.;Casper, R. F.
研究问题：与单独使用hCG相比，IVF周期中联合使用GnRH激动剂和人绒毛膜促性腺激素（hCG;双触发剂）是否能改善成熟卵母细胞数量和妊娠结局？简要答复：与单独使用hCG相比，使用双触发器进行最终卵泡成熟可以增加卵母细胞数量、成熟卵母细胞数量和囊胚数量（总数量和最高质量）。已知：hCG在控制性超促排卵结束时用作替代LH峰，以诱导最终卵母细胞成熟。最近，基于回顾性研究，GnRH激动剂和hCG的联合给药用于最终卵母细胞成熟研究设计、规模、持续时间：2016年5月至2018年6月间的单中心、随机对照、双盲临床试验，按意向治疗（ITT）进行分析。参与者/材料、设置、方法：155例正常反应患者随机接受hCG或双触发剂进行最终卵母细胞成熟。对患者年龄、BMI、AMH、获卵数、中期2（MII）卵母细胞数、受精卵和囊胚数、临床妊娠率和活产率等数据进行评估，并在双触发组和hCG组之间进行比较。我们在招募50%的患者后进行了计划的中期分析。基于在中期分析的总体结果，我们决定停止进一步的recruitment.Main结果和机会的作用：一百五十五例患者被纳入本研究。两组的年龄（36岁vs 35.3岁，P = NS）、BMI（24 kg/m2 vs 23.7 kg/m2）和AMH（20.1 pmol/l vs 22.4 pmol/l）相当。根据ITT分析，取卵数量（11.1对13.4，P = 0.002），MII卵母细胞（8.6 vs 10.3，P = 0.009），囊胚总数与hCG组相比，双触发组的囊胚移植率（2.9对3.9，P = 0.01）和优质囊胚移植率（44.7%对64.9%; P = 0.003）显著更高。临床妊娠率（24.3%对46.1%，OR 2.65（1.43-1.93），P = 0.009）和每次转移的活产率（22%对36.2%，OR = 1.98（1.05-3.75），P = 0.03）在双触发组中显著高于hCG组。研究结果的更广泛意义：如果双触发器的应用更广泛，观察到的增强反应可能会导致更好的IVF结局。
STUDY QUESTION: Does co-administration of GnRH agonist and Human chorionic gonadotropin (hCG; dual trigger) in IVF cycles improve the number of mature oocytes and pregnancy outcome compared to hCG alone?SUMMARY ANSWER: Using the dual trigger for final follicular maturation increases the number of oocytes, mature oocytes and number of blastocysts (total and top-quality) compared to triggering with hCG alone.WHAT IS KNOWN ALREADY: hCG is used at the end of controlled ovarian hyperstimulation as a surrogate LH surge to induce final oocyte maturation. Recently, based on retrospective studies, the co-administration of GnRH agonist and hCG for final oocyte maturation (dual trigger) has been suggested to improve IVF outcome and pregnancy ratesSTUDY DESIGN, SIZE, DURATION: A single center, randomized controlled, double-blinded clinical trial between May 2016 and June 2018 analyzed by intention to treat (ITT).PARTICIPANTS/MATERIALS, SETTINGS, METHODS: One hundred and fifty-five normal responder patients were randomized either to receive hCG or dual trigger for final oocyte maturation. Data on patients age, BMI, AMH, number of oocytes retrieved, number of metaphase 2 (MII) oocytes, zygotes and blastocysts, clinical pregnancy rate and live birth rate were assessed and compared between the dual trigger group and the hCG group. We performed a planned interim analysis after the recruitment of 50% of the patients. Based on the totality of outcomes at the interim analysis we decided to discontinue further recruitment.MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-five patients were included in the study. The age (36 years versus 35.3 years P = NS), BMI (24 kg/m(2) versus 23.7 kg/m(2)) and the AMH (20.1 pmol/l versus 22.4 pmol/l) were comparable between the two groups. Based on ITT analysis, the number of eggs retrieved (11.1 versus 13.4, P = 0.002), the MII oocytes (8.6 versus 10.3, P = 0.009), total number of blastocysts (2.9 versus 3.9, P = 0.01) and top-quality blastocysts transferred (44.7% versus 64.9%; P = 0.003) were significantly higher in the dual trigger group compared to the hCG group. The clinical pregnancy rate (24.3% versus 46.1%, OR 2.65 (1.43-1.93), P = 0.009) and the live birth rate per transfer (22% versus 36.2%, OR = 1.98 (1.05-3.75), P = 0.03) were significantly higher in the dual trigger group compared to the hCG group.LIMITATIONS, REASONS FOR CAUTION: None.WIDER IMPLICATIONS OF THE FINDINGS: The enhanced response observed with the dual trigger might lead to better IVF outcomes were it used more widely.