Online ISSN: 2577-5669

Comparing the Effectiveness of Standard, Dual, and Triple Triggering on Antagonist Cycles in IVF Outcomes for Patients with Poor Ovarian Response: A Randomized Controlled Trial

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Maryam Al Sadat Sharifi , Aliyeh Ghasemzadeh , Behrooz Nik Nafs , Laya Farzadi , Kobra Hamdi , Nazli Navali , Parvin Hakimi , Hosein Azizi , Minou Zarifian
» doi: 10.5455/jcmr.2024.15.01.05

Abstract

Background: The trend of delaying parenthood and increasing age of women during their first pregnancy are significant factors contributing to the rise in infertility. Consequently, infertility clinics are witnessing an increase in the number of women exhibiting poor ovarian response (POR) and less than optimal reactions to conventional stimulation techniques. This study aimed to assess the impact of standard, dual, and triple triggering on antagonist cycles in relation to in vitro fertilization (IVF) outcomes among patients with POR. Methods: In a clinical trial at Al-Zahra Educational Hospital, Tabriz, Iran, women with a POR were enrolled from March to September 2023. They were divided into three treatment groups, for triggering, Group I received human chorionic gonadotropin (hCG), Group II received hCG and Decapeptyl, and Group III received hCG, Decapeptyl, and menotropin (hMG). All treatments were administered via injection for stimulation, and oocyte retrieval was performed 36-40 hours post injection. The oocytes were retrieved and evaluated for maturation. Fertility rates were assessed at 24 h, and embryos were observed during the 48 h and 72 h intervals. All the embryos were freezing by vitrification technique. In the HRT cycles for endometrial preparation On the transfer day, endometrial thickness was measured, Two embryos in cleavage stage were transferred, and pregnancy was confirmed two weeks later using a clinical pregnancy test. All analyses were performed in SPSS software (version 22). A p-value of less than 0.05 was considered statistically significant. Results: This study included 108 patients who were eligible for POR. Of these, 20 patients (18.51%) had positive pregnancy test. chemical pregnancy was confirmed in 11.11% of patients in both the I and III groups and in 33.33% of the patients in the II group. However, there were no significant differences in chemical pregnancy rates among the three groups (P>0.05). Age, BMI, AMH, duration of infertility, number of simulation cycles, dose of hMG administration, dose of FSH administration, and endometrial thickness on the day of transfer showed no significant differences among the three groups (P>0.05). The II group had significantly higher numbers of MII oocytes and total oocytes, as well as a higher number of embryos after both 24 h and 72 h than the other groups (P<0.05). Conclusion: The study found no significant differences in positive pregnancy test results across the groups, possibly due to triptorelin’s minimal impact on fertility rates. It suggests that embryo quality is influenced by the patient’s condition and treatment process. The dual trigger method is recommended for POR patients as it led to higher embryo formation at 24 and 72 hours compared to the single and triple trigger groups. The study’s small sample size calls for further research with larger samples, and future studies should focus on pregnancy results and fetal outcomes.

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