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International Research Journal of Medical Sciences and Health Care

Open Access Peer Review International
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Efficacy and Reproductive Outcomes of Combined Versus Single Trigger Protocols in Assisted Reproductive Technology: A Meta-Analytical Study

DOI https://doi.org/10.55640/irjmshc-v03i10-01
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Kwame A. Mensah 1 , Ama E. Owusu 1 ,
4 School of Public Health, University of Ghana, Accra, Ghana
4 Department of Biomedical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Abstract

Ovulation triggering is a critical component of assisted reproductive technology (ART), as the final maturation of retrieved oocytes directly influences subsequent fertilization, embryo development, implantation, and reproductive outcomes. Conventional single-trigger protocols using human chorionic gonadotropin (hCG) have been widely applied, whereas combined or dual-trigger approaches incorporating a gonadotropin-releasing hormone (GnRH) agonist with hCG have been investigated as a strategy to reproduce more closely the physiological hormonal events associated with final follicular maturation. This study synthesizes the evidence provided in six studies examining dual versus single ovulation-trigger approaches in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), with particular attention to reproductive outcomes, ovarian response, live birth, and outcomes in women with diminished ovarian reserve or low response. The methodological approach is based on structured comparative synthesis of the supplied systematic reviews, meta-analyses, retrospective cohort evidence, and comparative clinical studies. The literature generally indicates that dual-trigger protocols may provide clinically meaningful advantages for selected patient populations, although the magnitude and consistency of benefit vary according to ovarian reserve, responder status, treatment characteristics, and outcome definitions. Evidence concerning live birth is particularly important because improvements in intermediate outcomes do not necessarily translate into superior cumulative reproductive success. The analysis highlights the potential value of individualized trigger selection while emphasizing heterogeneity, retrospective evidence, and limitations in direct comparability among studies.

Keywords

Assisted Reproductive Technology, IVF, ICSI, Dual Trigger

References

Dong L, Lian F, Wu H, Xiang S, Li Y, Wei C, et al. Reproductive outcomes of dual trigger with combination GnRH agonist and hCG versus trigger with hCG alone in women undergoing IVF/ICSI cycles: a retrospective cohort study with propensity score matching. BMC Pregnancy Childbirth. 2022;22(1):583. [PMID: 35869444, PMCID: PMC9308204].
Guner FC, Ozekinci M, Mendilcioglu II, Kasabali Z. Reproductive Outcomes of Dual Trigger versus hCG Alone in Women Undergoing In Vitro Fertilization with Fresh Embryo Transfer Cycles. Obstet Gynecol Int. 2024;2024:9972437. [PMID: 39015476, PMCID: PMC11251794].
Hu KL, Wang S, Ye X, Zhang D, Hunt S. GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials. Reprod Biol Endocrinol. 2021;19(1):78. [PMID: 34059045, PMCID: PMC8167939].
Lin MH, Wu FSY, Hwu YM, Lee RKK, Li RS, Li SH. Dual Trigger With Gonadotropin Releasing Hormone Agonist and Human Chorionic Gonadotropin Significantly Improves Live Birth Rate for Women With Diminished Ovarian Reserve. Obstetrical & Gynecological Survey. 2019;74(9):534-5.
Sloth A, Kjolhede M, Sarmon KG, Knudsen UB. Effect of dual trigger on reproductive outcome in low responders: a systematic PRISMA review and meta-analysis. Gynecol Endocrinol. 2022;38(3):213-21. [PMID: 34779694].
Zhang Y, Guo X, Guo L, Chang HM, Shu J, Leung PCK. Outcomes comparison of IVF/ICSI among different trigger methods for final oocyte maturation: A systematic review and meta-analysis. FASEB J. 2021;35(7):e21696. [PMID: 34085322].

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