Received August 02, 2022
Accepted February 21, 2023

Objectives: Conventionally hCG is used as a ‘faux’ LH surge to bring final oocyte maturation due to structural similarity with LH. GnRH-agonist though induces a more physiological gonadotropin surge for follicular maturation, but is associated with luteal phase deficiency. Our aim was to assess whether adding gonadotropin-releasing hormone agonist (GnRHa) to hCG trigger improves the oocyte maturation and the number of high-grade embryos in GnRH antagonist IVF-cycle. Methods: This was a single centre, open-labelled, randomized controlled trial including 100 patients between 21-38 years (tubal factor, male factor, unexplained infertility, with normal ovarian reserve) undergoing IVF using GnRH-antagonist protocol. Patients were randomized to receive either the dual-trigger(Leuprolide acetate 1 mg + rhCG 250 mcg, n=50) or single hCG trigger(rhCG 250 mcg, n=50). Analysis was done by ITT. Independent-t and chi-square tests was used for comparison of normally distributed quantitative variables and qualitative variables. Results: With similar baseline characteristics, the number of MII oocytes (7.82 versus 5.92, p=0.003) and day-3 grade-1 embryos (4.24 versus 1.8, p<0.001) and consequently, number of embryos cryopreserved (2.68 versus 0.94, p<0.001) were significantly higher in the dual-trigger group. However, the fertilization rates (91.82% versus 88.51%, p=0.184) and clinical pregnancy rate between the two groups (21% versus 19.6%, p=0.770) were comparable. The serum LH levels 12-hours post trigger was high in the dual-trigger group (46.23 mIU/ml vs 0.93 mIU/ml, p<0.0001). Conclusion: This study concludes that the addition of GnRHa to hCG trigger leads to the improved embryological outcomes and the possibility of cryopreserving surplus embryos thereby increasing the cumulative live-births.