OBJECTIVE: Spontaneous ovulation is preceded by a surge of both follicle stimulating hormone (FSH) and luteinizing hormone. Studies on serum and follicular fluid FSH suggest a potential role for FSH at the time of final oocyte maturation. Dual trigger have shown good outcomes in ART supporting role of FSH in oocyte maturation.We hypothesized that giving FSH Co-trigger along with the standard HCG trigger in poor responders and sub-optimal responders could improve developmental competence of the oocyte.
DESIGN: Prospective observational study done in tertiary care fertility centre between April 2017 to March 2018.
MATERIALS AND METHODS: The study was conducted over a perid of 1 year at Milann the fertility centre Bangalore. 63 patients in the age group of 25-45 years, with previous poor response or sub-optimal response to stimulation with one or more failed IVF cycles were included in the study. Antagonist protocol for IVF/ICSI was started after day2/3 scan and blood test. When 2 or more follicle of more than 17.5mm , trigger was given with 300IU of Recombinant FSH alond with 250mcg of Recombinant HCG. Ooocyte aspiration was done 35 hrs after trigger. .The primary outcomes -oocyte maturity rate, fertilization proportion, number of Grade 1 embryos obtained Secondary outcomes- oocyte recovery rate, cleavage rate and implantation rate.Statistical significance was evaluated through Wilcoxon Signed Ranks Test
RESULTS: Of the 63 patients, 2 were excluded and 5 dropped out. Number of oocytes retrived( 7.17 in co-trigger v/s 5.3 in HCG group, p value-0.006), number of mature oocytes(5.3 in co-trigger v/s 3.57 in HCG trigger, p value-0.003) , fertilization rate(5.03 in co-trigger v/s 3.13 in HCG trigger group, p value-0.002), cleavage rate(4.9 in co-trigger v/s 2.87 in HCG trigger group, p value-0.001) and otal number of Grade 1 embryos on Day 3 (3.87 in co-trigger v/s 2.03 in HCG trigger group, p value-0.0001) were higher in the Co-trigger group in comparison to HCG trigger group
CONCLUSIONS: In this study we noticed a significant improvement in outcome in FSH cotrigger group. Evidence from macaques has shown that midcycle recombinant FSH alone is able to promote resumption of oocyte meiosis, fertilization, and granulosa cell luteinization, though cannot sustain luteal function. Though GnRHa is a an alternative, there is a starkingly lower levels of FSH when compared to FSH co-trigger in follicular fluid.and GnRHa trigger is followed by massive leutiolysis favouring FSH co-trigger in poor and suboptimal responders.