Study question Are there any positive effects of triple trigger on oocyte morphology, embryo quality and pregnancy rates in poor responder (POR) patients? Summary answer The trigger with human chorionic gonadotropin (hCG), gonadotropin-releasing hormone agonist (GnRHa) and human menopausal gonadotropin (hMG) may improve embryo quality and pregnancy rates in POR. What is known already The ESHRE consensus criteria define a poor ovarian response (POR) as less than four oocytes retrieved. Advanced female age and severe sperm disorder were associated fertilization failure after intracytoplasmic sperm injection (ICSI). Also, oocyte quality is pivotal to determine the fertilization of the oocyte. Hence there is no study to evaluate triple trigger on the embryo quality in POR and severe male infertility are excluded. Study design, size, duration In this prospective randomized study, we analyzed poor responder patients that have history of fertilization failure and cleavage arrest embryo, including 100 patients with only hCG trigger (group 1), 100 patients with dual trigger hCG + GnRHa (Group 2), and 100 patients with triple trigger hCG + GnRHa + hMG (Group 3). Patients who have the POR criteria according to MII oocytes lower than 4 were included in the analysis. Participants/materials, setting, methods Mean age, body mass index (BMI), AMH levels, day-2 FSH and E2, duration of infertility, LH and E2 levels on trigger day, duration of stimulation, total dose of gonadotropins used, number of previous trials, MII oocytes were examined and compared between the groups. Sperm concentration under 5 x 106 mL was not included to exclude severe male factor. Embryo quality, pregnancy rates evaluation was performed for each patient that has been performed GnRH antagonist protocols. Main results and the role of chance Age, Body Mass Index (BMI), AMH levels, day 2 FSH and E2, duration of infertility, duration of stimulation, E2 levels on trigger day, and total dose of gonadotropins usage between the three groups were similar. Number of MII oocytes, fertilization (2PN), and D5 (blastocyst) embryo transfer were significantly higher in Group 3 (Table 1). Pregnancy rates are higher in group 3 however significantly not significant. Limitations, reasons for caution The study is limited by its sample size and a higher sample size might be used in the future studies to corroborate the current findings. hMG trigger dosage may be arranged in another study. Wider implications of the findings Our results showed that the number of MII oocytes 2PN levels, D5 ET were higher in DOR patients triggered with hCG + GnRHa + hMG. Trial registration number 28012022

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P-597 三重触发对低反应患者 IVF 结果和妊娠率的影响

研究问题 三重触发对低反应 (POR) 患者的卵母细胞形态、胚胎质量和妊娠率有积极影响吗？摘要答案 人绒毛膜促性腺激素 (hCG)、促性腺激素释放激素激动剂 (GnRHa) 和人绝经期促性腺激素 (hMG) 的触发可能会改善 POR 的胚胎质量和妊娠率。已知情况 ESHRE 共识标准将卵巢反应不良 (POR) 定义为取回的卵母细胞少于四个。高龄女性和严重的精子障碍与胞浆内精子注射 (ICSI) 后的受精失败有关。此外，卵母细胞质量是决定卵母细胞受精的关键。因此，没有研究评估 POR 中胚胎质量的三重触发因素，并且排除了严重的男性不育症。研究设计，大小，在这项前瞻性随机研究中，我们分析了有受精失败和卵裂停滞胚胎病史的低反应患者，包括 100 名仅触发 hCG 的患者（第 1 组）、100 名双触发 hCG + GnRHa 的患者（第 2 组）和 100三重触发 hCG + GnRHa + hMG 的患者（第 3 组）。根据 MII 卵母细胞的 POR 标准低于 4 的患者被纳入分析。参与者/材料、设置、方法平均年龄、体重指数 (BMI)、AMH 水平、第 2 天 FSH 和 E2、不孕持续时间、触发日的 LH 和 E2 水平、刺激持续时间、使用的促性腺激素的总剂量、数量在之前的试验中，MII 卵母细胞在各组之间进行了检查和比较。不包括 5 x 106 mL 以下的精子浓度以排除严重的男性因素。胚胎质量，对已执行 GnRH 拮抗剂方案的每位患者进行妊娠率评估。主要结果和机会 年龄、体重指数 (BMI)、AMH 水平、第 2 天 FSH 和 E2、不孕持续时间、刺激持续时间、触发日 E2 水平以及促性腺激素使用的总剂量在三组之间是相似的。第 3 组的 MII 卵母细胞数、受精 (2PN) 和 D5（胚泡）胚胎移植显着较高（表 1）。第 3 组的妊娠率较高，但显着不显着。局限性，谨慎的理由 该研究受到样本量的限制，未来的研究可能会使用更高的样本量来证实当前的研究结果。hMG 触发剂量可安排在另一项研究中。研究结果的更广泛意义 我们的结果表明，在由 hCG + GnRHa + hMG 触发的 DOR 患者中，MII 卵母细胞 2PN 水平、D5 ET 的数量较高。试用注册号28012022