Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Gynecol Endocrinol. 2016 Nov;32(11):861-865. doi: 10.1080/09513590.2016.1193141. Epub 2016 Jun 8.


The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro fertilisation (IVF) cycles. The concept being a ''dual trigger'' combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ''double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 h prior to ovum pick-up, respectively. The use of the ''double trigger" has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation.

Keywords: Combined ovulation triggering; GnRH agonist trigger; double trigger; dual trigger; hCG-triggering.

Publication types

  • Review

MeSH terms

  • Adult
  • Chorionic Gonadotropin / administration & dosage
  • Chorionic Gonadotropin / pharmacology*
  • Drug Therapy, Combination*
  • Female
  • Fertilization in Vitro / methods*
  • Gonadotropin-Releasing Hormone / administration & dosage
  • Gonadotropin-Releasing Hormone / agonists*
  • Gonadotropin-Releasing Hormone / pharmacology*
  • Humans
  • Ovulation Induction / methods*


  • Chorionic Gonadotropin
  • Gonadotropin-Releasing Hormone