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• W2890521862 abstract "Dual trigger protocol using a combination of GnRH agonist and hCG for final oocyte maturation has been shown to minimize ovarian hyperstimulation syndrome (OHSS) risk without compromising fresh embryo transfer outcomes1. However, other evidence suggests that patients with good ovarian reserve may benefit from freeze-all cycles due to supraphysiologic hormone levels affecting the uterine environment during the fresh cycle2. Therefore, we sought to determine if any cycle characteristics were associated with lower clinical pregnancy rates in the fresh cycle. Retrospective cohort study. All patients who underwent the dual trigger protocol and had a fresh embryo transfer 5 days after oocyte retrieval were included. Maternal age, BMI, gravidity, parity, antral follicle count (AFC), oocytes retrieved, endometrial thickness, number of embryos transferred and frozen were compared for subjects who achieved clinical pregnancy, defined as an intrauterine gestational sac confirmed by ultrasound, and those who did not. Mann Whitney-U test was used to compare demographic, cycle characteristics, and outcome data between groups. Medians with interquartile ranges are presented with p-values. Additional analysis between subjects who had <30 and ≥30 oocytes retrieved was conducted. Logistic regression was used to identify predictors of clinical pregnancy. A clinical pregnancy was confirmed for 196 (67%) of the 291 patients who underwent the dual trigger protocol with fresh embryo transfer. The cohort achieving clinical pregnancy had significantly lower age and a higher number of embryos cryopreserved (Table 1). After stratifying for number of oocytes retrieved, 216 (74%) patients had <30 oocytes and 75 (26%) had ≥30 oocytes, there was no difference in clinical pregnancy rates of 66.8% and 69.2% respectively. Logistic regression analysis identified number of embryos cryopreserved as the only parameter to predict clinical pregnancy, with an odds ratio of 1.079. There were no cases of OHSS in patients that underwent a fresh embryo transfer. This data supports the use of dual trigger to both minimize ovarian hyperstimulation risk as well as obtain appreciable pregnancy rates in the fresh cycle. The high number of oocytes obtained was not associated with lower pregnancy rates in the fresh cycle supporting fresh embryo transfers in this good prognosis group of patients.Table 1Cohort characteristicsClinical pregnancy (N=196) Median (IQR)No clinical pregnancy (N=95) Median (IQR)p-valueAge30.0 (28.0-33.0)31.0 (29.0-33.0)0.033BMI26.0 (22.8-31.9)25.8 (22.6-32.2)0.719Gravida0.0 (0.0-1.0)0.0 (0.0-1.0)0.733Para0.0 (0.0-0.0)0.0 (0.0-0.0)0.507Antral follicle count36.0 (29.0-41.0)37.0 (28.0-40.0)0.416Oocytes retrieved24.0 (19.0-30.0)23.0 (18.0-28.0)0.209Endometrial thickness (mm)10.9 (9.5-12.5)10.3 (9.2-12.1)0.060Fresh embryos transferred1.0 (1.0-1.0)1.0 (1.0-1.0)0.369Embryos frozen5.0 (2.0-8.0)3.0 (1.0-7.0)0.007 Open table in a new tab" @default.
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• W2890521862 date "2018-09-01" @default.
• W2890521862 modified "2023-10-17" @default.
• W2890521862 title "Pregnancy predictors in the fresh cycle using dual trigger" @default.
• W2890521862 doi "https://doi.org/10.1016/j.fertnstert.2018.07.608" @default.
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