Triggering final oocyte maturation. The role of human chorionic gonadotropin, gonadotropin-releasing hormone agonist, and dual trigger

Following the observations demonstrating comparable or even better oocyte\embryos quality following gonadotropin-releasing hormone agonist (GnRHa), compared to human chorionic gonadotropin (hCG) trigger, and the different effects of luteinizing hormone (LH) and hCG on the downstream signaling of the LH receptor, GnRHa is now offered concomitant to the standard hCG trigger dose to improve oocyte/embryo yield and quality. Three different modes of concomitant administration of both GnRHa and a standard bolus of hCG (5000-10,000 units) prior to oocyte pick-up (OPU) are suggested: (a) dual trigger 35-37h prior to OPU is offered to normal responders patients, resulting in improved oocyte/embryo quality and IVF outcome; (b) double trigger GnRHa 40h and standard hCG added 34h prior to OPU is offered to patients demonstrating abnormal final follicular maturation despite normal response to COH, resulting in significantly higher number of oocytes retrieved, higher number of mature/metaphase-II (MII) oocytes, and proportion of MII oocytes per number of oocytes retrieved, with the consequent significantly increased number of top-quality embryos; and (c) double or dual trigger 34h before OPU is offered to poor responders patients, aiming to overcome premature luteinization, while achieving high yield of mature oocytes.