PDF(Pubmed)
Abstract：
METHODS: The purpose of this study was to assess whether the implementation of a \"dual trigger\" approach, utilizing gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) in the GnRH antagonist protocol for in vitro fertilization (IVF), leads to improved pregnancy outcomes compared to the conventional hCG trigger alone. Previous meta-analyses have not provided sufficient evidence to support the superiority of the dual trigger over the hCG trigger in fresh or frozen embryo transfer cycles. Thus, a systematic review and meta-analysis of randomized trials were conducted to provide a comprehensive evaluation of the impact of the dual trigger on pregnancy outcomes in fresh or frozen embryo transfer cycles.
METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted. We searched the Medline and Embase databases for articles up to 2023 by using search terms: \"dual trigger,\" \"GnRHa,\" \"hCG,\" \"IVF.\" Eligible RCTs comparing the dual trigger with the hCG trigger were included. The primary outcome was the live birth rate (LBR) per cycle. The secondary outcomes were the number of oocytes retrieved, number of mature oocytes retrieved, implantation rate, biochemical pregnancy rate, CPR, miscarriage rate and ovarian hyperstimulation syndrome (OHSS) rate per started cycle We compared the oocyte maturation and pregnancy outcomes in the dual trigger and hCG trigger groups. In patients undergoing fresh embryo transfer (ET) and frozen-thawed ET, we also conducted a subgroup analysis to evaluate whether dual trigger improves the clinical pregnancy rate (CPR).
RESULTS: We included 10 randomised studies, with 825 participants in the dual trigger group and 813 in the hCG trigger group. Compared with the hCG trigger, dual trigger was associated with a significant increase in the LBR per cycle (odds ratio (OR) = 1.61[1.16, 2.25]), number of oocytes retrieved (mean difference [MD] = 1.05 [0.43, 1.68]), number of mature oocytes retrieved (MD = 0.82 [0. 84, 1.16]), and CPR (OR = 1.48 [1.08, 2.01]). Subgroup analyses revealed that dual trigger was associated with a significantly increased CPR in patients who received fresh ET (OR = 1.68 [1.14, 2.48]). By contrast, the dual trigger was not associated with an increased CPR in the patient group with frozen-thawed ET (OR = 1.15 [0.64, 2.08]).
CONCLUSIONS: The dual trigger was associated with a significantly higher number of retrieved oocytes, number of mature oocytes, CPR, and LBR in IVF than the hCG trigger. The beneficial effect for fresh ET cycles compared with frozen-thawed ET might be associated with increased endometrial receptivity.
CONCLUSIONS: After dual trigger, delaying ET due to the concern of endometrial receptivity might not be needed.
METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted. We searched the Medline and Embase databases for articles up to 2023 by using search terms: \"dual trigger,\" \"GnRHa,\" \"hCG,\" \"IVF.\" Eligible RCTs comparing the dual trigger with the hCG trigger were included. The primary outcome was the live birth rate (LBR) per cycle. The secondary outcomes were the number of oocytes retrieved, number of mature oocytes retrieved, implantation rate, biochemical pregnancy rate, CPR, miscarriage rate and ovarian hyperstimulation syndrome (OHSS) rate per started cycle We compared the oocyte maturation and pregnancy outcomes in the dual trigger and hCG trigger groups. In patients undergoing fresh embryo transfer (ET) and frozen-thawed ET, we also conducted a subgroup analysis to evaluate whether dual trigger improves the clinical pregnancy rate (CPR).
RESULTS: We included 10 randomised studies, with 825 participants in the dual trigger group and 813 in the hCG trigger group. Compared with the hCG trigger, dual trigger was associated with a significant increase in the LBR per cycle (odds ratio (OR) = 1.61[1.16, 2.25]), number of oocytes retrieved (mean difference [MD] = 1.05 [0.43, 1.68]), number of mature oocytes retrieved (MD = 0.82 [0. 84, 1.16]), and CPR (OR = 1.48 [1.08, 2.01]). Subgroup analyses revealed that dual trigger was associated with a significantly increased CPR in patients who received fresh ET (OR = 1.68 [1.14, 2.48]). By contrast, the dual trigger was not associated with an increased CPR in the patient group with frozen-thawed ET (OR = 1.15 [0.64, 2.08]).
CONCLUSIONS: The dual trigger was associated with a significantly higher number of retrieved oocytes, number of mature oocytes, CPR, and LBR in IVF than the hCG trigger. The beneficial effect for fresh ET cycles compared with frozen-thawed ET might be associated with increased endometrial receptivity.
CONCLUSIONS: After dual trigger, delaying ET due to the concern of endometrial receptivity might not be needed.
摘要：
方法：这项研究的目的是评估是否实施了“双重触发”方法，利用促性腺激素释放激素激动剂（GnRHa）和人绒毛膜促性腺激素（hCG）在GnRH拮抗剂方案中进行体外受精（IVF），与单独使用常规hCG触发器相比，妊娠结局得到改善。先前的荟萃分析没有提供足够的证据来支持在新鲜或冷冻胚胎移植周期中双重触发优于hCG触发。因此，我们对随机试验进行了系统评价和荟萃分析,以全面评价在新鲜或冷冻胚胎移植周期中双重触发因素对妊娠结局的影响.
方法：对随机对照试验（RCTs）进行系统评价和荟萃分析。我们在Medline和Embase数据库中搜索了2023年之前的文章，使用搜索词：“双重触发，\"\"GnRHa,\"\"hCG,\"\"试管婴儿。“纳入了比较双重触发和hCG触发的合格随机对照试验。主要结果是每个周期的活产率（LBR）。次要结果是检索到的卵母细胞数量，回收的成熟卵母细胞数量，植入率,生化妊娠率，CPR,我们比较了双触发和hCG触发组的卵母细胞成熟和妊娠结局。在接受新鲜胚胎移植（ET）和冻融ET的患者中，我们还进行了一项亚组分析,以评估双触发因素是否能提高临床妊娠率(CPR).
结果：我们纳入了10项随机研究，双触发组中有825名参与者，hCG触发组中有813名参与者。与hCG触发器相比，双触发因素与每个周期LBR的显着增加相关（比值比（OR）=1.61[1.16，2.25]），检索到的卵母细胞数（平均差[MD]=1.05[0.43，1.68]），恢复的成熟卵母细胞数(MD=0.82[0.84，1.16])，和CPR(OR=1.48[1.08,2.01])。亚组分析显示，在接受新鲜ET的患者中，双重触发因素与CPR显著增加相关（OR=1.68[1.14,2.48]）。相比之下,在有冻融ET的患者组中,双重触发因素与CPR增加无关(OR=1.15[0.64,2.08]).
结论：双重触发因素与获得的卵母细胞数量显著增加有关，成熟卵母细胞的数量，CPR,IVF中的LBR比hCG触发。与冻融ET相比，新鲜ET周期的有益作用可能与子宫内膜容受性增加有关。
结论：双重触发后，可能不需要因子宫内膜容受性而延迟ET。
方法：对随机对照试验（RCTs）进行系统评价和荟萃分析。我们在Medline和Embase数据库中搜索了2023年之前的文章，使用搜索词：“双重触发，\"\"GnRHa,\"\"hCG,\"\"试管婴儿。“纳入了比较双重触发和hCG触发的合格随机对照试验。主要结果是每个周期的活产率（LBR）。次要结果是检索到的卵母细胞数量，回收的成熟卵母细胞数量，植入率,生化妊娠率，CPR,我们比较了双触发和hCG触发组的卵母细胞成熟和妊娠结局。在接受新鲜胚胎移植（ET）和冻融ET的患者中，我们还进行了一项亚组分析,以评估双触发因素是否能提高临床妊娠率(CPR).
结果：我们纳入了10项随机研究，双触发组中有825名参与者，hCG触发组中有813名参与者。与hCG触发器相比，双触发因素与每个周期LBR的显着增加相关（比值比（OR）=1.61[1.16，2.25]），检索到的卵母细胞数（平均差[MD]=1.05[0.43，1.68]），恢复的成熟卵母细胞数(MD=0.82[0.84，1.16])，和CPR(OR=1.48[1.08,2.01])。亚组分析显示，在接受新鲜ET的患者中，双重触发因素与CPR显著增加相关（OR=1.68[1.14,2.48]）。相比之下,在有冻融ET的患者组中,双重触发因素与CPR增加无关(OR=1.15[0.64,2.08]).
结论：双重触发因素与获得的卵母细胞数量显著增加有关，成熟卵母细胞的数量，CPR,IVF中的LBR比hCG触发。与冻融ET相比，新鲜ET周期的有益作用可能与子宫内膜容受性增加有关。
结论：双重触发后，可能不需要因子宫内膜容受性而延迟ET。
