Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 16 , ISSUE 4 ( October-December, 2022 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Comparative Study of Dual Trigger vs hCG Trigger in Intrauterine Insemination Cycles

Swati Yadav, Sonal Panchal, Chaitanya Nagori, Sushma Nadagouda, Manish Thakker

Keywords : Dual trigger, Follicle stimulating hormone surge, Gonadotropin-releasing hormone agonist, Human chorionic gonadotropin, Intrauterine insemination, Ovulation trigger

Citation Information : Yadav S, Panchal S, Nagori C, Nadagouda S, Thakker M. Comparative Study of Dual Trigger vs hCG Trigger in Intrauterine Insemination Cycles. Donald School J Ultrasound Obstet Gynecol 2022; 16 (4):266-271.

DOI: 10.5005/jp-journals-10009-1944

License: CC BY-NC 4.0

Published Online: 26-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: The aim of this study was to assess if follicle-stimulating hormone (FSH) surge induced by gonadotropin-releasing hormone agonist (GnRHa), when given in addition to human chorionic gonadotropin (hCG) for triggering ovulation in intrauterine insemination (IUI) cycles, was beneficial and resulted in higher pregnancy rates. Background: Gonadotropin-releasing hormone agonist (GnRHa), when given as an ovulation trigger, causes a surge of both FSH and luteinizing hormone (LH) due to its “flare” effect mimicking the midcycle surge of gonadotropins in a natural cycle. The role of midcycle FSH surge in humans is not completely understood. But when GnRHa alone is used as an ovulation trigger, it causes luteolysis and luteal phase defect due to its shorter duration of action. In IUI cycles, GnRHa can be combined with hCG, which is responsible for only LH surge, and compared with cycles in which hCG alone is used as a trigger to analyze the impact of midcycle FSH on clinical pregnancy rates. Materials and methods: A total of 60 IUI cycles were analyzed that were divided into two groups. Group I received hCG alone and group II received hCG + GnRHa for ovulation trigger. In both groups stimulation protocol used was letrozole, which started from day 2 of the cycle for 5 days, and recombinant FSH (rFSH) from day 7. Follicular monitoring was done using two-dimensional (2D) ultrasound and color Doppler. Once follicles and endometrium attained functional maturity, an ovulation trigger was given. In group I, recombinant hCG and in group II, triptorelin acetate (0.2 mg) along with recombinant hCG was given. In both groups, IUI was done 34–36 hours after the trigger; luteal support was given with 800 mg micronized vaginal progesterone per day. Clinical pregnancy rates were compared in both groups. Results: There was a difference in pregnancy rates between the hCG group (26.7%) and GnRHa + hCG group (40%). Conclusion: It was concluded that though there was a difference in pregnancy rates in both groups, the difference was not statistically significant due to the small patient cohort (p = 0.273).


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