Does a dual-trigger treatment improve IVF outcomes in older patients with diminished ovarian reserve?

This study investigated if a dual-trigger treatment (DTT) improves pregnancy outcomes in older women with diminished ovarian reserve (DOR). 

They found that DTT improved in vitro fertilization (IVF) outcomes in these women.

In vitro fertilization (IVF) is an assisted reproductive technique (ART). The first step of IVF is controlled ovarian stimulation (COS). This triggers the release of oocytes (eggs) from the ovaries. Oocytes are then harvested for IVF. Human chorionic gonadotropin (hCG) is a drug used for COS. It is effective but can have side effects. One of these is ovarian hyperstimulation syndrome (OHSS). Gonadotropin-releasing hormone agonists (GnRHa) are also COS drugs. They are more effective at stimulating oocyte maturation (OM). However, this treatment is associated with lower pregnancy rates. 

Studies suggest combining hCG and GnRHa is safe and more effective. This is called dual-trigger treatment (DTT). Most of these studies were performed in women that are normal responders. The situation is less clear for women with diminished ovarian reserve (DOR). Women with DOR usually release fewer oocytes during COS. It is unclear if DTT improves IVF outcomes in women with DOR.

This study included women that underwent 308 IVF cycles. Women had an average age of 40 years. One group underwent DTT (hCG and GnRHa) for final OM. The control group was treated with hCG only for OM. IVF outcomes included the number of oocytes retrieved (NOR) and the number of fertilized oocytes (NFO). Other outcomes included clinical pregnancy (CPR) and live birth rate (LBR).

The NOR (3.3 vs 1.6) and NFO (2.4 vs 1.2) were significantly higher in the DTT group vs the control group. The number of high-quality embryos was also higher in the DTT group (0.9 vs 0.2).

The CPR (23.1% vs 8.7%) and LBR (17.5% vs 5.4%) were significantly higher in the DTT group vs the control group. DTT was associated with a 3.16-fold chance of a live birth. There was a 4.3-fold higher chance of achieving a clinical pregnancy with DTT. There was no difference in the miscarriage rate between the two groups.

The authors concluded that DTT improved IVF outcomes in older women with DOR.

Women were assigned to DTT or hCG only at the discretion of their doctor. This could bias the results in this study. A randomized controlled study is needed.