JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):238
Poster Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263843
P-226. The Impact of Elevated BMI on Trigger Strategies in ICSI Cycles: Preliminary Data from an Age-Matched Retrospective Cohort Study
Ângela Marcon D´Avila1, Flávia Gobetti Gomes1, Maite Daniela Del Collado2, Daniela Paes Almeida Braga2, Gustavo Feijó Vieira1
1 Embrios Centro de Reprodução Humana - Bento Gonçalves - RS – Brasil
2 Science For Everymind - São Paulo – SP - Brasil
Objective: Women with elevated body mass index (BMI) often present hormonal distribution imbalances, frequently requiring higher doses of gonadotropins during controlled ovarian stimulation. Consequently, the potential benefit of a dual trigger, using both GnRH agonist and hCG to achieve higher levels of LH-activity molecules, has been hypothesized in this population. However, the impact of single versus dual trigger strategies on oocyte retrieval, maturation, and embryo development outcomes remains unclear. This study aimed to evaluate the effect of trigger type on laboratory outcomes of ICSI cycles among women with elevated BMI.
Methods: This retrospective cohort study included ICSI cycles conducted between 2023 and 2025 in women with a BMI above 25. Cycles were divided into two groups according to the trigger strategy used: those triggered with GnRH agonist alone (AGONIST group: 83 cycles) and those with a combination of GnRH agonist and hCG (DUAL group: 62 cycles). Propensity Score Matching (PSM) was performed to match for female age, using a 1:1 ratio, resulting in 62 cycles per group. After matching, baseline characteristics were compared using Student's t-test for normally distributed variables and the Mann–Whitney U test for non-normally distributed ones. The effect of trigger strategy on oocyte retrieval rate, oocyte maturity rate, fertilization rate, cleavage rate, and blastocyst formation rate were analyzed using generalized linear models (GLMs). Models were adjusted for potential confounders, such as anti-Müllerian hormone (AMH) levels and antral follicle count (AFC). Statistical analyses were performed using R software (version 4.5.1), and a p-value<0.05 was considered statistically significant.
Results: Following PSM, no statistically significant differences were identified between the DUAL and AGONIST groups regarding female age (35.74±0.59 vs. 35.40±0.61 years; p=0.6918), BMI (28.42±0.40 vs. 28.82±0.49; p=0.5319), or duration of ovarian stimulation (13.27±0.24 vs. 13.26±0.23 days; p=0.8764). In contrast, the DUAL group exhibited significantly lower antral follicle count (11.95±0.78 vs. 18.28±1.00; p<0.001) and anti-Müllerian hormone levels (1.31±0.19 vs. 3.61±0.68; p=0.0014) when compared to the AGONIST group. After adjusting for AFC and AMH, no statistically significant differences were observed between groups in terms of oocyte recovery rate (73.73%±8.34 vs. 76.73%±7.91), pr mature (MII) oocytes rate (79.07%±4.66 vs. 84.27%±4.42), fertilization rate (81.3%±4.2 vs. 84.39%±3.84), rate of top-quality cleaved embryos (39.23%±8.76 vs. 57.53%±8.25), blastocyst formation rate (46.27%±8.11 vs. 37.4%±7.42), or rate of top-quality blastocysts (23.16%±5.68 vs. 22.65%±5.35). However, a statistically significant difference was observed in the cleavage rate, which was higher in the DUAL group compared to the AGONIST group (96.54%±8.36 vs. 66.16%±8.88; p=0.0226).
Conclusion: The data from our preliminary study suggest that the dual trigger with GnRH agonist and hCG does not provide any benefit compared to the GnRH agonist trigger alone in terms of oocyte recovery, maturity rates, or embryo development rates in women with a BMI above 25. Further studies with larger cohorts are needed to better elucidate the potential impact of trigger strategies in this population.