Dual Trigger with Gonadotropin Releasing Hormone Agonist and Human Chorionic Gonadotropin of Fresh Autologous Cycles in High Responders: A Systematic Review

Background: the purpose of the current study was to investigate the effect of coadministration of human chorionic gonadotropin (hcg) with gonadotropin releasing hormone agonist (gnrh-a) trigger (dual trigger) in high responders for fresh autologous cycles in order to investigate the pregnancy outcomes and rates of ovarian hyperstimulation syndrome (ohss) in comparison to gnrh-a trigger alone. methods: a systematic search was performed in pubmed and ovid medline from inception through february 2020. the included materials were case-control, cohort and, cross-sectional studies as well as clinical trials in which the outcomes of dual trigger with gnrh-a were compared for final oocyte maturation in high responders undergoing gnrh-ant cycles. results: five retrospective studies were included for this review. three of the studies showed that the use of dual trigger versus gnrh-a trigger resulted in no statistically significant difference in rates of ohss while achieving a statistically significant difference in favor of the dual trigger group in ongoing pregnancy rates, early pregnancy loss, and fertilization rates. conclusion: currently, there is insufficient evidence to support improved clinical pregnancy rate, fertilization rate, live birth rate, and early pregnancy loss rate by the use of dual trigger versus gnrh-a trigger. larger double-blind clinical studies are required to properly evaluate the efficacy of this protocol for use in high responders.