Journal of Assisted Reproduction and Genetics

, Volume 33, Issue 9, pp 1175–1184 | Cite as

GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone

  • Kathleen E. O’NeillEmail author
  • Suneeta Senapati
  • Ivy Maina
  • Clarisa Gracia
  • Anuja Dokras
Assisted Reproduction Technologies



The purpose of this study was to compare rates of ovarian hyperstimulation syndrome (OHSS) after using gonadotropin-releasing hormone agonists (GnRHa) alone and GnRHa in combination with low-dose human chorionic gonadotropin (hCG, dual trigger) for final oocyte maturation in women undergoing controlled ovarian hyperstimulation (COH).


A retrospective cohort study was conducted at an academic center. Study population included 108 women who received GnRHa trigger and 66 women who received dual trigger (GnRHa + low-dose [1000 IU] hCG trigger). The main outcome measure was OHSS. Secondary outcomes included total oocyte yield and oocyte maturity.


The incidence of early OHSS was significantly higher after dual trigger than GnRHa trigger (8.6 vs 0 %). Moreover, four of the six patients that developed OHSS developed severe OHSS. Logistic modeling revealed that the combination of age, BMI, baseline AFC, and E2 >4000 pg/mL was predictive of OHSS with an area under the receiver operating characteristic curve of 0.84 and was superior to each factor alone. Adjusted analyses revealed that dual trigger was associated with a higher number of total oocytes (adjusted OR 1.27; 95 % confidence interval, 1.18, 1.38) and percentage of mature oocytes (AOR 1.10; 95 % confidence interval, 1.03, 1.17) obtained compared to GnRHa trigger alone.


Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with a significantly increased risk of severe OHSS compared to GnRH alone. However, dual trigger may be associated with a modest increase in oocyte yield, both in terms of number and maturity.


Dual trigger GnRHa trigger Low-dose hCG Oocyte maturity OHSS 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kathleen E. O’Neill
    • 1
    Email author
  • Suneeta Senapati
    • 1
  • Ivy Maina
    • 2
  • Clarisa Gracia
    • 1
  • Anuja Dokras
    • 1
  1. 1.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynecologyUniversity of PennsylvaniaPennsylvaniaUSA
  2. 2.School of MedecineUniversity of PennsylvaniaPhiladelphiaUSA

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