Human chorionic gonadotropin (HCG)alone versus HCG in combination with gonadotropin releasing hormone agonist as a trigger in ICSI cycles procedure

  • Hazem H. Ahmed
  • Reham Hussien
  • Sayed Ahmed M. Taha
Keywords: Intra Cytoplasmic Sperm Injection (ICSI), Gonadotropin Releasing hormone (GnRH)


Study Design: A case control study
OBJECTIVE: The aim of this study was to compare HCG triggering versus HCG with GnRh
agonist in ICSI cycles as regard number of mature metaphase 2 oocyt retrieved and ongoing
outcome up to positive pregnancy test..
SETTING: Assisted reproductive unit - Obstetrics and Gynecology Department of Qena
university hospital.
SAMPL SIZE: 50 patient.
PATIENTS AND METHODS: This study was done on 50 infertile women recruited from those
attendanting outpatient infertility clinic of obstetrics and gynecology department , Qena
University Hospital and undergoing ICSI procedure with antagonist protocol at assisted
reproductive unit of Qena university hospital. Exclusion criteria included _Antimullerian
hormone <0.5 ng/ml., Antral follicular count <4, Patient with polycystic ovary syndrome as
defined by (Rotterdam criteria 2003), Patient with uterine abnormality, Patient with abnormal
endocrine function ( DM, thyroid disorder, adrenal abnormality), Patient with general disease
(uncontrolled HTN, renal disease), Patient with endometriotic ovarian cysts, Patient with
azospermic partner. A written consent was obtained from all participants according to the
Medical Ethics Committee of the Faculty of Medicine ,south valley university.
Methods: Patients are categorized in two groups. Group A (control) were assigned to the HCG
triggering alone, whereas group B(cases) received the dual triggering (HCG plus GnRH agonist).
Since the primary endpoint is the number of oocytes retreived, sample size calculation was
performed in order to detect a difference in the mean number of oocytes retrieved between the
two groups.
Both groups received induction with controlled ovarian stimulation according to antagonist
protocol, then follow up folliculometry till more than 3 follicles each more than 18mm were
obtained, then trigger was given according to group. Within 36hr oocyte retrevial was done.
Embryo cultured to be transferred on day 5 with good luteal phase support & pregnancy test after
14 day was done.
At the end of the treatment cycle we recorded in each patient the number of mature metaphase 2
oocytes retreived, fertilized oocytes , transfered embryos and cryopreserved embryos.
Comparison of continuous variables between the two groups was performed using t-test.
RESULTS: mean M2 oocytes in group A patient was 9.80±6.95 , while in group B patient
was7.16±5.55 with P-value of 0.145 . As regard mean of frozen embryo it was 2.76±3.25 in
group A patient ,while 5.16±4.80 in group B patient with significant difference ( P- value 0.044)
About number of positive pregnancy test in both group it was 14 cases in group A ,compaired to
only 10 cases in group B.
CONCLUSION: in ICSI cycles using antagonist protocol double trigger using HCG&GnRH
agonist is associated with more number of M 2 oocyt, more good quality embryos, yet less
pregnancy rates.
RECOMMENDATIONS: double trigge use in antagonist protocol of ICSI cycles patient can be
used for obtaining more number of M2 oocytes as well as good quality embryos, and as regard
unexplained lower pregnancy rates frozen embryos transferre in other cycle may be tried.