July 21st, 2018

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Comparison of the Clinical Outcomes of Using Three Different Trigger Programs in PCOS Patients Undergoing Artificial Insemination with Husband’s Semen
Authors:  Tianyang Gao, M.D., Haiyu Tang, M.D., Yan Quan, M.D., Xin Ren, Jin Wu, M.D., Jin Li, M.D., and Yihua Wu
  OBJECTIVE: To compare the clinical outcomes of gonadotropin-releasing hormone agonist (GnRHa), human chorionic gonadotropin (hCG) alone, or a combination of GnRHa and hCG in polycystic ovary syndrome (PCOS) patients undergoing ovulation induction.

STUDY DESIGN: We retrospectively analyzed 104 cases of PCOS patients who underwent artificial insemination with husband’s semen (AIH) using hCG (hCG group, 39 cases), GnRHa (GnRHa group, 31 cases), or a combination of GnRHa and hCG (dual trigger group, 34 cases) to induce follicular maturation. We compared the ovulation number, ovulation rate, clinical pregnancy rate, live birth rate, and the incidence of ovarian hyperstimulation syndrome (OHSS) in the 3 groups.

RESULTS: The 3 groups did not differ in the number of dominant follicles, E2 levels on hCG day, the number of ovulation, and the ovulation rate, but the incidence of OHSS in the hCG group was significantly higher than that in the GnRHa and dual trigger groups (15.4% vs. 0% and 2.9%, respectively, p=0.01). However, there was no difference in OHSS occurrence between the GnRHa and dual trigger groups. The clinical pregnancy rate was higher in the dual trigger group than in the GnRHa group (32.4% vs. 9.7%, p=0.03). There was no statistically significant difference in the live birth rate among the 3 groups, but there was an increasing tendency in the dual trigger group as compared with other 2 groups (23.5% vs. 6.5% and 15.4%, respectively).

CONCLUSION: Dual trigger in combination with GnRHa and low-dose hCG could optimize clinical pregnancy rates in PCOS patients undergoing AIH and does not increase the risk of OHSS. Dual trigger maintained the clinical pregnancy rate and live birth rate, and there was an increasing tendency as compared with using hCG.
Keywords:  AIH; artificial insemination, husband; assisted reproductive techniques; GnRHa; gonadotropin-releasing hormone; hCG; human chorionic gonadotropin; insemination, artificial, homologous; ovarian hyperstimulation syndrome; ovulation induction; polycystic ovarian syndrome; reproductive technology, assisted
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