Clinical efficacy of dual trigger with human chorionic gonadotropin and a gonadotropin-releasing hormone agonist for women undergoing fertility preservation.
Hong. Yeon Hee YH; Kim. Seul Ki SK; Lee. Jung Ryeol JR; Jee. Byung Chul BC; Suh. Chang Suk CS
Key Findings
- Overall egg and mature egg counts were similar between hCG alone and hCG + triptorelin groups
- In breast/endometrial cancer patients using letrozole, the dual trigger yielded significantly more mature oocytes (6.9 ± 6.0 vs 4.6 ± 3.6)
- Maturation rate was higher with the dual trigger but didn’t reach statistical significance
Practical Outcomes
- If you’re a cancer patient undergoing fertility preservation with a letrozole‑based protocol, adding 0.2 mg triptorelin to the hCG trigger may boost the number of mature eggs you retrieve. For general fertility or performance‑enhancement goals, the extra peptide isn’t shown to provide a benefit.
Summary
Adding a small dose of the peptide triptorelin (a GnRH‑agonist) to the usual hCG trigger didn’t change overall egg numbers, but in breast or endometrial cancer patients who were also taking letrozole, it gave them more mature eggs than hCG alone. For most people the extra step isn’t needed, but it could be useful in specific fertility‑preservation cases.
Abstract
To determine the optimal maturation method to increase the yield of mature oocytes, especially for cancer patients with fewer chances of fertility preservation (FP) before gonadotoxic therapy. A total of 373 cycles in 293 patients undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin-releasing hormone (GnRH) antagonist protocol were enrolled. The control group (<i>n =</i> 225) received 250 µg of recombinant human chorionic gonadotropin (rhCG) while the study group (<i>n =</i> 148) received 250 µg of rhCG and 0.2 mg of triptorelin for triggering. Subgroup analyses were performed for stimulation cycles with diminished ovarian reserve (DOR; anti-Müllerian hormone (AMH) levels <1.1 ng/ml, <i>n =</i> 86), with endometrioma (<i>n =</i> 104), or with breast cancer and endometrial cancer using 5 mg of letrozole during the COS cycles (<i>n =</i> 84). There was no significant difference in the baseline characteristics or the number of total and mature oocytes between the two groups. Subgroup analyses for women with endometrioma or DOR showed similar results. However, the dual trigger group had a significantly higher number of mature oocytes than the rhCG trigger group in breast and endometrial cancer patients using letrozole during the COS cycles (6.9 ± 6.0 vs. 4.6 ± 3.6, <i>p</i> = 0.034). The maturation rate was higher in the dual trigger group, although the difference was not statistically significant (59.3 ± 26.7 vs. 50.0 ± 28.0, <i>p</i> = 0.124). Dual triggering can be an efficient maturation method to maximize the yield of mature oocytes in breast or endometrial cancer patients using letrozole-combined GnRH antagonist protocol for FP.
Study Information
pubmed
2022
2022-02-04T00:00:00.000Z
10.1002/rmb2.12440
9
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