The Impact Of Dual Trigger Stimulation Upon Reproductive Outcomes In Woman Of Advanced Maternal Age – A Large Retrospective Study

Background Poor ovarian response (POR) in women aged 40 and above presents significant challenges in in vitro fertilization (IVF). This study evaluated whether dual trigger strategy, involving a combination of gonadotropin-releasing hormone (GnRH) agonists and human chorionic gonadotropin (hCG), improves IVF outcomes compared to human chorionic gonadotropin (hCG) alone in women of advanced maternal age. Methods A retrospective cohort study was conducted, analysing 2,199 IVF cycles from 1,451 women between January 2018 and June 2022. Among these cycles, 327 cycles utilized a dual trigger strategy while 1,124 had an hCG trigger. Key outcomes assessed included the number of metaphase II (MII) oocytes, fertilization rates, fresh embryo transfers on days 5/6, and pregnancy outcomes. Multivariate regression was employed to adjust for variables such as age, BMI, gonadotropin dosage, stimulation duration, and anti-Müllerian hormone levels. Results The dual trigger group showed significantly higher rates of embryo transfer on days 5/6 (34.1% vs. 16.5%, p < 0.001). While there were no significant differences in the number of MII oocytes or fertilization rates (p = 0.16), adjusted analysis indicated a modest increase in MII oocytes (RR = 1.1, 95% CI 1.00–1.21). Positive hCG rates were lower in the dual trigger group (18.5% vs. 24.7%, p = 0.007), and cumulative live birth rates were not significantly different (8.9% vs. 13.2%, p = 0.009). Conclusions Dual trigger protocols may enhance certain ovarian response parameters but do not significantly improve pregnancy or live birth rates in older women with diminished ovarian reserve. Future studies are necessary to optimize and personalize treatment strategies for this challenging patient population. Trial Registration: Approved by the local ethical committee (Approval 17/07/2024).