Trigger agents and post-trigger testing

Human chorionic gonadotropin (hCG), gonadotropin-releasing hormone agonist (GnRHa), or both in the form of dual trigger can be used to induce final oocyte maturation. We assessed if dual trigger with GnRHa (leuprolide acetate), plus urinary hCG, improves outcomes in minimal stimulation in vitro fertilization (IVF) cycles for patients with expected poor ovarian response (POR). With a first cycle analysis, we observed that dual trigger did not increase oocyte and mature oocyte yield in expected POR patients undergoing minimal stimulation IVF cycles. Therefore, single full-dose urinary hCG trigger may still be preferred for minimal stimulation IVF cycles in expected POR patients. Appropriate laboratory testing before and after trigger may be beneficial for prediction of stimulation outcomes. Pre-trigger estradiol (E2) can predict the oocyte yield in women undergoing minimal and/or mild stimulation IVF, whereas post-trigger follicle-stimulating hormone (FSH) levels have a negative correlation with oocyte yield. Post-trigger E2, progesterone, and hCG levels may only be useful to assure patient compliance and the drug potency after hCG trigger, but they do not predict minimal/mild stimulation IVF outcomes.