{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:00:31Z","timestamp":1780398031944,"version":"3.54.1"},"reference-count":18,"publisher":"Knowledge E DMCC","issue":"4","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["knepublishing.com"],"crossmark-restriction":true},"short-container-title":["IJRM"],"abstract":"<jats:p>Background: Diminished ovarian reserve is one of the most important issues in in vitro fertilization cycles. Some authors have reported beneficial effects of dual triggering in women with poor ovarian response, whereas other investigators have demonstrated contrary results.\r\nObjective: The study aims to investigate the effect of final follicular maturation using a dual trigger (human chorionic gonadotropin [HCG] plus gonadotropin-releasing hormone [GnRH] agonist) compared to HCG alone in GnRH-antagonist cycles on oocyte retrieval, maturation, embryo quality, and clinical pregnancy in frozen cycles.\r\nMaterials and Methods: This single-blind randomized clinical trial was conducted from May and November 2019 on 80 infertile women with poor ovarian response undergoing an intracytoplasmic sperm injection-embryo transfer cycle with a GnRH-antagonist protocol. All participants received 10,000 IU of urinary HCG for final oocyte maturation. The dual trigger group received an additional 0.2 mg of triptorelin acetate, while the HCG alone group did not. The primary outcome was the clinical pregnancy rate. Secondary outcomes included the number of oocytes retrieved, mature oocytes, fertilization rate, embryo quality, implantation rate, and miscarriage rate.\r\nResults: The dual trigger group showed a significantly higher number of total oocytes, metaphase II oocytes, good-quality embryos, and implantation rate compared to the HCG alone group (p \u2264 0.050). However, no significant difference was observed between the groups in clinical pregnancy or abortion rates (p &gt; 0.050).\r\nConclusion: Final oocyte maturation using a dual trigger (GnRH agonist + HCG) improves the number of good-quality embryos and can be a practical approach to enhance the efficiency of the fertilization process in infertile women with diminished ovarian reserve.<\/jats:p>","DOI":"10.18502\/ijrm.v24i4.21171","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:36:34Z","timestamp":1780392994000},"update-policy":"https:\/\/doi.org\/10.18502\/knecrossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of dual trigger on pregnancy outcomes in women with diminished ovarian reserve: A single-blind randomized clinical trial"],"prefix":"10.18502","volume":"24","author":[{"given":"Marzieh","family":"Zamaniyan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahereh","family":"Abbasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manizheh","family":"Habibpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Peyvandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Jafarpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza Ali Mohammadpour","family":"Tahamtan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noushin","family":"Gordani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7770","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"333539","unstructured":"[1] Zamaniyan M, Farshidfar B, Peyvandi S, Jafarpour H, Taheripanah R, Moradi S, et al. Effects of dehydroepiandrosterone on the response of ovarian stimulation during in vitro fertilization cycle in infertile women with diminished ovarian reserve: Before and after clinical trials. Crescent J Med Biol Sci 2019; 6: 287\u2013292."},{"key":"333540","doi-asserted-by":"crossref","unstructured":"[2] Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Mohesen MN, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev 2014; 10: CD008046.","DOI":"10.1002\/14651858.CD008046.pub4"},{"key":"333541","doi-asserted-by":"crossref","unstructured":"[3] Esteves SC, Yarali H, Vuong LN, Carvalho JF, \u00d6zbek \u0130Y, Polat M, et al. Cumulative delivery rate per aspiration IVF\/ICSI cycle in POSEIDON patients: A real-world evidence study of 9073 patients. Hum Reprod 2021; 36: 2157\u20132169.","DOI":"10.1093\/humrep\/deab152"},{"key":"333542","unstructured":"[4] Papadopoulos KI, Anifandis G, Chatzimeletiou K, Grimbizis G, Tarlatzis BC, Giannakou A, et al. Tailored ovarian stimulation for poor responders: A randomized trial comparing antagonist versus agonist protocols in women aged < 35 versus \u2265 35. Fertil Steril 2022; 117: 747\u2013756."},{"key":"333543","unstructured":"[5] Zhao Y, Wang Y, Zhang J, Liu J, Chen L, Yang S, et al. Dual trigger (GnRH agonist + hCG) versus hCG alone in normal responders: A multicenter randomized controlled trial. Fertil Steril 2023; 120: 789\u2013797."},{"key":"333544","doi-asserted-by":"crossref","unstructured":"[6] de Oliveira SA, Calsavara VF, Cort\u00e9s GC. Final oocyte maturation in assisted reproduction with human chorionic gonadotropin and gonadotropin-releasing hormone agonist (dual trigger). JBRA Assist Reprod 2016; 20: 246\u2013250.","DOI":"10.5935\/1518-0557.20160047"},{"key":"333545","doi-asserted-by":"crossref","unstructured":"[7] Lin MH, Wu FS, Lee RK, Li SH, Lin SY, Hwu YM. Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles. Fertil Steril 2013; 100: 1296\u20131302.","DOI":"10.1016\/j.fertnstert.2013.07.1976"},{"key":"333546","doi-asserted-by":"crossref","unstructured":"[8] Chen K, Zhang CM, Chen LX, Zhao Y, Li HZ. Dual trigger improves oocyte yield and embryo quality in women with diminished ovarian reserve: A retrospective study. Reprod Biol Endocrinol 2024; 22: 115.","DOI":"10.1186\/s12958-024-01211-z"},{"key":"333547","doi-asserted-by":"crossref","unstructured":"[9] Riob\u00f3 A, Mart\u00ednez Acosta A, Martinez-Rocca L, Taboas E, L\u00f3pez de Uralde B, Fernandez I, et al. Dual triggering for final oocyte maturation: A narrative review. Front Endocrinol 2025; 16: 1556732.","DOI":"10.3389\/fendo.2025.1556732"},{"key":"333548","doi-asserted-by":"crossref","unstructured":"[10] lleyassin A, Ghasemi M, Aghahosseini M, Safdarian L, Sarvi F, Almasi-Hashiani A, et al. Final oocyte maturation with a dual trigger compared to human chorionic gonadotropin trigger in antagonist co-treated cycles: A randomized clinical trial. Middle East Fertil Soc J 2018; 23: 199\u2013204.","DOI":"10.1016\/j.mefs.2018.01.001"},{"key":"333549","doi-asserted-by":"crossref","unstructured":"[11] Mercorio A, Conforti A, Pluchino N, Drakopoulos P, Giudice M, Giampaolino P, et al. Efficacy of dual triggering in poor ovarian responders defined according to Bologna and POSEIDON criteria: A systematic review with meta-analysis. J Assist Reprod Genet 2026; 43: 1063\u20131077.","DOI":"10.1007\/s10815-026-03821-5"},{"key":"333550","doi-asserted-by":"crossref","unstructured":"[12] Hsia L-H, Lee T-H, Lin Y-H, Huang Y-Y, Chang H-J, Liu Y-L. Dual trigger improves the pregnancy rate in fresh in vitro fertilization (IVF) cycles compared with the human chorionic gonadotropin (hCG) trigger: A systematic review and meta-analysis of randomized trials. J Assist Reprod Genet 2023; 40: 2063\u20132077.","DOI":"10.1007\/s10815-023-02888-8"},{"key":"333551","unstructured":"[13] Hafezi M, Arabipoor A, Zareei M, Vesali S, Mostafaei P, Zameni N. The effect of dual trigger on IVF\/ICSI outcomes in patients with suboptimal ovarian response (POSEIDON group I): A randomized clinical trial. Int J Fertil Steril 2025; 19: 251\u2013258."},{"key":"333552","doi-asserted-by":"crossref","unstructured":"[14] Gao F, Wang Y, Fu M, Zhang Q, Ren Y, Shen H, et al. Effect of a dual trigger using a GnRH agonist and hCG on the cumulative live-birth rate for normal responders in GnRH-antagonist cycles. Front Med 2021; 8: 683210.","DOI":"10.3389\/fmed.2021.683210"},{"key":"333553","doi-asserted-by":"crossref","unstructured":"[15] Gupta D, Sood A, Mathur R. GnRH agonist trigger in modern reproductive medicine practice- when, why, and how? Fertil Sci Res 2022; 9: 80\u201386.","DOI":"10.4103\/fsr.fsr_26_22"},{"key":"333554","doi-asserted-by":"crossref","unstructured":"[16] He Z, Guo N, Yao Y, Zhou J, Deng T, Du Y, et al. The effects of GnRH analogues on endometrial receptivity: A comprehensive study. J Assist Reprod Genet 2025; 42: 2313\u20132323.","DOI":"10.1007\/s10815-025-03495-5"},{"key":"333555","doi-asserted-by":"crossref","unstructured":"[17] Alsahlani E, Khadem N, Mahmoudinia M, Khazaee A, Sadeghi T, Mahmoudinia M, et al. Comparison of GnRH agonist, hCG, and dual trigger for final oocyte maturation in IVF cycles. Int J Women\u2019s Health Reprod Sci 2024; 12: 167\u2013173.","DOI":"10.15296\/ijwhr.2024.6015"},{"key":"333556","doi-asserted-by":"crossref","unstructured":"[18] Chen K, Zhang C, Chen L, Zhao Y, Li H. Reproductive outcomes of dual trigger therapy with GnRH agonist and hCG versus hCG trigger in women with diminished ovarian reserve: A retrospective study. Reprod Biol Endocrinol 2024; 22: 35.","DOI":"10.1186\/s12958-024-01211-z"}],"container-title":["International Journal of Reproductive BioMedicine (IJRM)"],"original-title":[],"link":[{"URL":"https:\/\/knepublishing.com\/index.php\/ijrm\/article\/download\/21171\/31923","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/knepublishing.com\/index.php\/ijrm\/article\/download\/21171\/31923","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:00:56Z","timestamp":1780394456000},"score":1,"resource":{"primary":{"URL":"https:\/\/knepublishing.com\/index.php\/ijrm\/article\/view\/21171"},"secondary":[{"URL":"http:\/\/ijrm.ir\/article-1-3675-en.html","label":"UNIVERSITY"}]},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,6,2]]}},"URL":"https:\/\/doi.org\/10.18502\/ijrm.v24i4.21171","relation":{},"ISSN":["2476-3772","2476-4108"],"issn-type":[{"value":"2476-3772","type":"electronic"},{"value":"2476-4108","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,2]]}}}