背景:双触发器的利用,涉及促性腺激素释放激素激动剂(GnRH-a)和人绒毛膜促性腺激素(hCG)的共同给药,用于最终的卵母细胞成熟,在控制性卵巢过度刺激(COH)期间,促性腺激素释放激素拮抗剂(GnRH-ant)方案正在成为一种新方法。该方案涉及在卵拾取(OPU)之前40和34小时施用GnRH-a和hCG,分别。这种治疗方式已经在卵母细胞产量低/差的患者中实施。这项研究旨在确定双重触发是否可以改善少于三个TQE的患者的优质胚胎(TQE)数量。
方法:分析了35个体外受精(IVF)周期的刺激特征。这些周期是由hCG和GnRHa(双触发周期)的组合触发的,并与相同患者先前的IVF尝试相比,其利用hCG触发器(hCG触发器控制周期)。该分析涉及2018年1月至2022年12月期间进入我们生殖中心的病例。在hCG触发控制周期中,所有35例患者的TQE均少于3例.
结果:接受双触发周期的患者产生的2PN卵裂胚胎数量明显更高(3.54±3.37vs.2.11±2.15,P=0.025),TQE(2.23±2.05vs.0.89±0.99,P<0.001),同时卵裂期胚胎数量的比例更高(53.87%±31.38%vs.39.80%±29.60%,P=0.043),2PN卵裂期胚胎(43.89%±33.01%vs.27.22%±27.13%,P=0.014),和TQEs(27.05%±26.26%与14.19%±19.76%,P=0.019)与hCG触发控制周期相比,检索到的卵母细胞数,分别。双触发周期实现了更高的累积临床妊娠率(20.00%vs.2.86%,P=0.031),累积持续性妊娠(14.29%vs.0%,P<0.001),和累积活产(14.29%vs.0%,与hCG触发对照周期相比,每个刺激周期P<0.001)。
结论:GnRH激动剂和hCG共同给药用于最终卵母细胞成熟,在OPU之前40和34小时,分别(双触发)可能被认为是治疗先前hCG触发IVF/卵胞浆内单精子注射(ICSI)周期中TQE产量低的患者的有价值的新方案.
BACKGROUND: The utilization of a double trigger, involving the co-administration of gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) for final oocyte maturation, is emerging as a novel approach in gonadotropin-releasing hormone antagonist (GnRH-ant) protocols during controlled ovarian hyperstimulation (COH). This protocol involves administering GnRH-a and hCG 40 and 34 h prior to ovum pick-up (OPU), respectively. This treatment modality has been implemented in patients with low/poor oocytes yield. This study aimed to determine whether the double trigger could improve the number of top-quality embryos (TQEs) in patients with fewer than three TQEs.
METHODS: The stimulation characteristics of 35 in vitro fertilization (IVF) cycles were analyzed. These cycles were triggered by the combination of hCG and GnRHa (double trigger cycles) and compared to the same patients\' previous IVF attempt, which utilized the hCG trigger (hCG trigger control cycles). The analysis involved cases who were admitted to our reproductive center between January 2018 and December 2022. In the hCG trigger control cycles, all 35 patients had fewer than three TQEs.
RESULTS: Patients who received the double trigger cycles yielded a significantly higher number of 2PN cleavage embryos (3.54 ± 3.37 vs. 2.11 ± 2.15, P = 0.025), TQEs ( 2.23 ± 2.05 vs. 0.89 ± 0.99, P < 0.001), and a simultaneously higher proportion of the number of cleavage stage embryos (53.87% ± 31.38% vs. 39.80% ± 29.60%, P = 0.043), 2PN cleavage stage embryos (43.89% ± 33.01% vs. 27.22% ± 27.13%, P = 0.014), and TQEs (27.05% ± 26.26% vs. 14.19% ± 19.76%, P = 0.019) to the number of oocytes retrieved compared with the hCG trigger control cycles, respectively. The double trigger cycles achieved higher rates of cumulative clinical pregnancy (20.00% vs. 2.86%, P = 0.031), cumulative persistent pregnancy (14.29% vs. 0%, P < 0.001), and cumulative live birth (14.29% vs. 0%, P < 0.001) per stimulation cycle compared with the hCG trigger control cycles.
CONCLUSIONS: Co-administration of GnRH-agonist and hCG for final oocyte maturation, 40 and 34 h prior to OPU, respectively (double trigger) may be suggested as a valuable new regimen for treating patients with low TQE yield in previous hCG trigger IVF/intracytoplasmic sperm injection (ICSI) cycles.