双扳机会增加成熟卵泡数，提高妊娠率或活产率吗？

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Study question

研究问题

Among patients undergoing ovarian stimulation for ICSI, does dual trigger with hCG and GnRH agonist offer any benefit over mono trigger with hCG alone?

在卵巢刺激后行ICSI的患者中，绒促性素（HCG）配伍促性腺激素释放激素激动剂（GnRHa）双扳机是否优于HCG单扳机。

Summary answer

结论总结

Dual trigger is associated with a higher number of mature oocytes without any impact on the pregnancy rate.

双扳机与更多的卵泡数相关，但并不影响妊娠率。

What is known already

既往已知

In ART cycles, final oocyte maturation and resumption of meiosis are generally triggered by the administration of hCG as a surrogate for the natural LH surge. Several studies have investigated the role of a combination of a bolus of GnRH agonists and hCG to mimic the natural peak of endogenous LH and FSH, without clear answers regarding clinical benefit. A meta-analysis showed highernumbers of good-quality embryos and increased ongoing pregnancy rate after dual trigger and a recent systematic review demonstrated significantly higher live birth rate (LBR) per cycle after administration of dual trigger compared to hCG-only trigger.

在辅助生殖技术（ART）周期中，常用HCG替代自然周期中LH峰，促发卵泡的最后成熟和启动减数分裂。有多项研究，旨在阐明GnRHa配伍HCG模拟自然周期中内源性的FSH和LH峰的作用，但在临床受益方面尚无明确结果。一项荟萃分析显示双扳机可获得更多的优质胚胎，持续妊娠率也增加。最近的一项系统回顾指出，与HCG单扳机相比，双扳机明显提高了每周期的活产率。

Study design, size, duration

研究设计、规模、时长

The study was a retrospective, single-centre cohort study. In this study, 8,525 ICSI cycles were included between January 2017 and April 2022 at a tertiary referral University Hospital. We included all patients undergoing ICSI in a GnRH antagonist ovarian stimulation cycle. The mono trigger consisted of recombinant or highly purified urinary hCG. In the dual trigger group, a bolus of GnRH agonist was combined with the hCG trigger.

此研究为回顾性、单中心队列研究。本研究共纳入2017年1月至2022年4月一家大学附属三级医院的8525个周期。纳入患者均在拮抗剂周期后行单精子胞浆内注射（ICSI）。单扳机组使用重组或高纯化尿HCG。双扳机组使用单剂GnRHa和HCG。

Participants/materials, setting, methods

研究对象/材料、设定、方法

Our cohort of 8,525 cycles was divided into two groups: Group A, the mono trigger group, (7,022 cycles), and Group B, the dual trigger group (1503 cycles). Patients who underwent IVF, pre-implantation genetic testing, oocyte donation, and fertility preservation were excluded. Patients with uterine anomalies and endocrine disorders were also excluded, as well as patients who received a triptorelin-only trigger because of hyperresponse.

将8525个周期分为两组：组A：单扳机组（7022个周期）；组B：双扳机组（1503个周期）。行体外受精（IVF）、植入前基因诊断、供卵、生育力保存的患者除外。子宫异常、内分泌疾病以及因卵巢高反应而单用曲普瑞林扳机的患者除外。

Main results and the role of chance

主要结果及几率

There was no difference in the mean age between the dual vs mono trigger cohorts (35.93 ± 4.90 vs 35.52±4.85). The most common indication for ART was male factor infertility in both groups (21.36% in group B vs 27.11% in group A). Stimulation was shorter in the dual trigger cohort (10.41 vs 12.08 p = 0.04). The total number of cumulus oocyte complexes (8.26±5.32 vs 7.45±4.68, p < 0.001), mature oocytes (6.39±4.15 vs 5.99±3.80, p = 0.006) and fertilized oocytes (4.79±3.59 vs 4.33±3.27, p = <0.001) was higher in the dual trigger group compared to those in the mono trigger group. Day 5 embryo transfer was more prevalent in the dual trigger group (46.07% vs 33,84%, p < 0.001). Embryo utilization rate was higher in group A (61.37% ±31.98) than in group B (53.47% ±30.91 p = <0.001). Ongoing regnancy rate was similar in both groups (27.29% in group A vs 27.08% in group B). Pearson chi2, Mann Whitney and logistic regression tests were used for the analysis.

两组患者的平均年龄无差异（35.93±4.90 vs 35.52±4.85）。两组中行ART最常见的指征为男性因素不孕（21.36% 组B vs 27.11% 组A）。双扳机队列中卵巢刺激周期较短（10.41 vs 12.08 p=0.04）。双扳机组获卵数（8.26±5.32 vs 7.45±4.68，p＜0.001），成熟卵母细胞数（6.39±4.15 vs 5.99±3.80，p=0.006）、受精卵数（4.79±3.59 vs 4.33±3.27，p=＜0.001）均高于单扳机组。双扳机组第五天胚胎移植率更高（46.07% vs 33.84%，p＜0.001）。单扳机组胚胎利用率更高（单扳机组61.37%±31.98%；双扳机组53.47%±30.91% p=＜0.001）。两组持续妊娠率相似（单扳机组 27.29% vs 双扳机组 27.08%）。数据分析采用卡方检验，Mann-Whitney逻辑回归。

Limitations, reasons for caution

局限性

In spite of the large sample, this study is retrospective and holds the possibility of unmeasured confounders.

尽管样本数量较大，但本研究为回顾性研究，可能包含不可测定的混杂因素。

Wider implications of the findings

研究结果的深层意义

Although a dual trigger may increase the number of mature oocytes, this does not translate into a higher pregnancy nor live birth rate. Reduced oocyte competence of the “surplus” oocytes may underlie this observation. Further research should identify specific subgroups that may benefit from dual trigger across meaningful outcome parameters.

尽管双扳机可能增加成熟卵泡数量，但并不因此意味着妊娠率或活产率的增加。这项研究可能是建立在“过剩”的卵泡数量会降低卵母细胞的功能的基础上的。进一步的研究应针对从有意义的结果参数中，确定从双扳机中受益的特殊亚群。

文章来源：C Blockeel, M P Agius, S De Rijdt, H Tournaye, M De Vos, P Drakopoulos, O-294 Dual trigger versus hCG-only trigger in ICSI patients: an analysis of 8500 cycles, Human Reproduction, Volume 38, Issue Supplement_1, June 2023, dead093.358, https://doi.org/10.1093/humrep/dead093.358