Received February 01, 2021
Accepted August 06, 2021

Objective: To evaluate if ovarian response to controlled ovarian stimulation (COS) and intracytoplasmic sperm injection (ICSI) outcomes are improved by the use of dual trigger (gonadotropin-releasing hormone (GnRH) agonists plus recombinant human chorionic gonadotropin (r-hCG)) in patients with previous cycles triggered with r-hCG. Methods: This case-control study included 88 matched cycles performed in 88 patients, which had the first ICSI cycle triggered with r-hCG (n=44) and the following ICSI cycle with dual trigger (n=44). Cycles outcomes were compared between the groups. In a second case-control within-subject analyses, we compared the ICSI outcomes between patients which had the first ICSI cycle triggered with r-hCG only (n=18) and the following ICSI cycle with dual trigger (n=18) or r-hCG only (n=18). Results: When repeated cycles (r-hCG only vs. dual trigger) were investigated, it was observed higher oocyte yield and mature oocyte rate, lower immature oocyte rate, higher fertilization rate, and higher blastocyst development rate, and higher rates of cycles with embryo transferred and implantation were observed in the dual trigger cycle. Conclusion: The dual trigger regimen is a more effective approach than r-hCG trigger in patients with a previous r-hCG triggered ICSI cycle, yielding improved response to COS, and laboratorial and clinical outcomes.