A Study On The Effect Of HCG Combined With GnRHa Trigger In The Antagonist Protocol On The Out Come Of Fresh Cycle Patients

Objective:The Gonadotropin releasing Hormone Antagonist(GnRH-A)protocol is one of the classic protocols used in assisted reproductive technology which includes in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI).Due to its flexibility,short stimulation time of Gonadotropin,high safety and wide applicability are applied in clinical practice.Human chorionic gonadotropin has been the gold standard for triggering final oocyte maturation in IVF and intracytoplasmic sperm injection(ICSI)cycles.The sustained luteinizing activity induced by hCG promotes the occurrence of ovarian hyperstimulation syndrome(OHSS),the most common and life-threatening complication of ovarian stimulation.With the development of assisted reproductive technology(ART)in modern times,it has been reported that the use of gonadotropin releasing hormone agonist(GnRHa)can effectively reduce the incidence of ovarian hyperstimulation syndrome and promote oocyte maturation.But it reduces the rate of embryo implantation and increases the rate of miscarriage,which may be due to GnRHa leading to impaired luteal function.Many studies have shown that gonadotropin-releasing hormone agonist(GnRHa)combined with hCG trigger which can significantly reduce the incidence of OHSS.But compared with hCG trigger,whether double trigger could improve pregnancy outcome is still controversial.How to improve the pregnancy outcome of patients without increasing the risk of OHSS is a clinical issue that reproductive doctors need to overcome.This study aims to compare the pregnancy outcomes of normal responders who use dual trigger or hCG trigger in antagonist protocol.Methods:The data of 2442 infertile patients who received assisted reproductive technology at the Reproductive center of The third hospital of Guangzhou Medical University from January 2020 to December 2022 and applied antagonist protocol to stimulate ovarian were selected for retrospective analysis.The data was divided into 3 groups according to the age and AMH.Group 1 : age≤35;Group 2:35<age≤38;Group3:age>38.Each group was divided into hCG alone trigger(hCG subgroup)and dual trigger which is a combination of GnRH agonist and hCG(GnRHa+hCG subgroup),and subgroup analysis was carried out.Resuits:In the IVF/ICSI fresh cycle antagonist protocol,for people with normal ovarian reserve,the use of GnRHa combined with hCG trigger cannot improve clinical pregnancy outcomes and embryonic laboratory indicators.For the age ≤ 35 year group,there was no statistically significant difference in clinical pregnancy rates between the two groups(P>0.05).But after regression analysis,the clinical pregnancy rate of the GnRHa combined with hCG group was lower than that of the hCG trigger group(P<0.05)and the incidence of moderate to severe OHSS in the GnRHa combined with hCG group was lower than that of the hCG group(P<0.05),but after regression analysis there were no statistical difference.There were no statistical difference in the cancellation cycle rate,implantation rate,hCG positive rate,ectopic pregnancy rate,biochemical pregnancy loss rate,and early abortion rate(P>0.05).The number of eggs obtained,2PN number,D3 available embryos,and excellent embryos in the GnRHa combined with hCG group were lower than those in the hCG group(P<0.05).And there was no statistically significant difference in MII number between the two trigger groups(P>0.05);For the 35 year old<age ≤ 38 year old group,there was no statistically significant difference in clinical pregnancy rate between the two trigger groups.There were no statistically significant difference in cancellation cycle rate,implantation rate,hCG positive rate,ectopic pregnancy rate,biochemical pregnancy loss rate,early abortion rate,and incidence of moderate to severe OHSS(P>0.05);But after regression analysis showed that dual trigger reduced the risk of early miscarriage.There were no statistically significant difference in the number of retrieved eggs,2PN number,D3 available embryos,excellent embryos,and MII number between the two trigger groups.For the age group>38 years old,the clinical pregnancy rate of the GnRHa combined with hCG group was higher than that of the hCG group(P<0.05),but after regression analysis,there was no statistically significant difference between the two groups.There was no statistically significant difference in the cancellation cycle rate,implantation rate,hCG positive rate,ectopic pregnancy rate,biochemical pregnancy loss rate,and early abortion rate(P>0.05),The number of 2PNs in the GnRHa combined with hCG group were higher than those in the hCG group(P<0.05).There were no statistical difference in the cancellation cycle rate,implantation rate,hCG positive rate,ectopic pregnancy rate,biochemical pregnancy loss rate,early abortion rate,and incidence of moderate to severe OHSS(P>0.05).Conclusion:In the IVF/ICSI fresh cycle antagonist protocol,for people with normal ovarian reserve,the pregnancy outcomes of dual trigger and hCG trigger were comparable from the overall population analysis.The dual trigger group reduced clinical pregnancy rates in age ≤ 35 years old group;For the 35 year old<age ≤ 38 year old group,dual triggers did not improve pregnancy outcomes;For individuals aged>38years,dual triggers can increase the number of 2PNs but cannot improve pregnancy outcomes...