Gaye ARSLAN, Gökçenur KARAKELLEOĞLU, Nuh Mehmet ERBAKIRCİ, Reyhan ASLANCAN BAYRAM, Yasin CEYLAN
Anatolian Journal of Obstetrics and Gynecology Research - 2025;2(3):111-116
Purpose: To compare the clinical and embryological outcomes of dual trigger gonadotropin releasing hormone (GnRH) agonist + human chorionic gonadotropin (hCG) versus hCG-only trigger in POSEIDON group 3 and 4 patients who are characterized by poor ovarian reserve and low prognosis undergoing in vitro fertilization. Methods: This retrospective study included women diagnosed with poor ovarian response (POSEIDON groups 3 and 4) who underwent controlled ovarian stimulation in GnRH antagonist cycles between January 2020 and January 2024. Patients were divided into two groups: the dual trigger group (DTG) received 0.2 mg triptorelin +250 mcg hCG for final oocyte maturation; the control group (CG) received only 250 mcg hCG. Both groups received growth hormone (GH) co-treatment and luteal phase hormone support. Embryos were frozen when progesterone exceeded 1.5 ng/mL on the trigger day . Outcomes included oocyte yield, embryo transfer rates, and pregnancy outcomes. Results: The study cohort consisted of 243 women, with 118 in the DTG and 125 in the CG. The DTG had significantly higher gonadotropin consumption and embryo transfer rates (both p<0.001), especially day 3 transfers. However, there were no significant differences between the groups in the number of oocytes retrieved, fertilization rates, implantation rates (9.3% vs. 10%, p=0.8), clinical pregnancy rates (10.6% vs. 9.9%, p=0.8), or live birth rates per transfer (9.7% vs. 8.9%, p=0.8). Conclusion: The dual trigger protocol resulted in increased gonadotropin use and embryo transfer rates but did not improve pregnancy or live birth outcomes. These results suggest that the benefits of dual trigger may be limited by the underlying ovarian reserve, and additional adjuvant therapies, such as GH supplementation, may be required to optimize reproductive outcomes in this challenging patient population.
