Salwa Sadoon AL-JUBORY, Manal Taha AL-OBAIDI
Perinatal Journal - 2026;34(2):166-177
It is imperative to optimize ovulation trigger strategies to elevate oocyte maturity, endometrial receptivity and pregnancy in ICSI cycles. Dual trigger (GnRH agonist and hCG) and FSH co-trigger are more physiological options that have been proposed to replace the conventional hCG. The purpose of the present study was to compare dual trigger, FSH co-trigger and conventional hCG trigger protocols during the ICSI cycles with respect to ovarian response, endometrial receptivity as well as clinical outcomes such as fertilization, clinical pregnancy and implantation rates. This is a prospective comparative randomized study that included 102 infertile women who had controlled ovarian stimulation using GnRH antagonist protocol at the Higher Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University. There was a similarity in baseline demographic characteristics and infertility profiles among the study groups. Outcome measures were parameters of ovarian responses (oocyte retrieval rate, oocyte maturity, fertilization, outcomes) and receptivity parameters (endometrial thickness, sub-endometrial Doppler indices) assessed on the day of oocyte pick-up and at the time of embryo transfer and(pregnancy ,implantation rates) The dual trigger and FSH co-trigger conditions had a significantly higher rate of oocyte retrieval, metaphase II (MII) oocytes, oocyte maturation rate and 2PN pronuclei Zygotes, than the traditional hCG group. Both improved triggering protocols were also linked with increased endometrial thickness and stronger changes of uterine and sub-endometrial resistance and pulsatility indices between the triggering day and embryo transfer, which shows better uterine perfusion. Not all of the intergroup differences were statistically significant even though the trend in the dual trigger group had the most desirable result to achieve elevated rates of implantation and clinical pregnancy. Dual and FSH trigger protocols showed an improved performance over the traditional, hCG triggering protocols regarding oocyte retrieval rate, total numbers of mature (MII) oocytes, oocyte maturation rate, normal fertilization (2PN), pregnancy rate and endometrial receptivity indices.
