The Effect of Dual Trigger (GnRH Agonist + hCG) for Final Maturation in Oocyte Donors With History of a Previous Cycle With Suboptimal Response to GnRH Agonist Only Trigger

The Effect of Dual Trigger (GnRH Agonist + hCG) for Final Maturation in Oocyte Donors With History of a Previous Cycle With Suboptimal Response to GnRH Agonist Only Trigger

The goal of this clinical trial is to compare GnRH-agonist trigger with dual GnRH-agonist and HCG trigger in oocyte donors.

The main questions it aims to answer are:

• Maturation rate (Metaphase II/ Total number of COCs collected)
• Fertilization rate
• Embryo quality day 3
• Fragmentation rate embryo day 3
• Blastulation rate (Day5/6/7)
• Quality of blastocyst (Gardner criteria) Participants will undergo controlled ovarian stimulation with a GnRH antagonist protocol Researchers will compare the effects of final maturation with GnRH-agonist trigger to a dual trigger (hCG and GnRH-a)

Final oocyte maturation is a critical step in the process of the Assisted Reproductive Technology (ART) treatment and has a certain impact on oocyte yield and oocyte competency. There are three different types of trigger: hCG, GnRH-agonist or dual trigger (hCG and GnRH-agonist combined), and the choice depends on the ovarian stimulation protocol, the ovarian response and on the clinical standard of the IVF clinic. As oocyte donors are at high risk for OHSS, a GnRH-agonist trigger (GnRH-a) is the most commonly used modality for triggering final maturation. However, a certain number of oocyte donors may have a suboptimal response to GnRH-a trigger only, with a yield of oocytes less than the 10th percentile, with a clear negative impact on oocyte efficiency and competency. This study aims to evaluate whether oocyte competence can be improved in oocyte donors with a previously suboptimal response to GnRH-a, by using a dual trigger in a subsequent ovarian stimulation cycle, in which hCG is added to the GnRH-agonist for final maturation

Inclusion Criteria:

• BMI: 18 - 25
• AMH: 1-3ng/ml
• AFC: 15
• Peak E2 in previous ovarian stimulation cycle: < 4000 pg/ml
• Ovarian response in first stimulation cycle: < 20 follicles over 10mm in total, at time of triggering
• Peak E2 in study cycle: < 4000 pg/ml
• Suboptimal response to trigger medication at first stimulation cycle
• Male age < 50 years old with normospermia

Exclusion Criteria:

• Oocyte donors which are at risk for development of ovarian hyperstimulation syndrome (OHSS)