OBJECTIVE To compare efficacy and safety of hCG, GnRH agonist, dual, and double triggers in predicted normal responders undergoing ovarian stimulation and IVF DESIGN: A systematic review and network meta-analysis of randomized controlled trials (RCTs). DATA SOURCES RCTs indexed in PubMed, MEDLINE, EMBASE, clinical trial registries and Cochrane Database of Systematic Reviews up to December 2023. STUDY SELECTION AND SYNTHESIS Twelve high-integrity RCTs comprising 1,931 women were included, which compared hCG trigger to GnRH agonist trigger, dual trigger, and double trigger. Statistical analysis was performed using STATA version 16. MAIN OUTCOMES Key outcomes included clinical pregnancy rates (CPR), live birth rates (LBR), number of oocytes, number of mature oocytes, miscarriage rate and rates of ovarian hyperstimulation syndrome (OHSS). RESULTS The network meta-analysis for CPR were relative risk (RR) 1.13 (95% Confidence Interval (CI):0.80-1.60) for hCG versus GnRH agonist trigger, RR 1.23 (95% CI:0.92-1.65) for hCG versus dual trigger, RR 0.38 (95% CI:0.21-0.69) for hCG versus double trigger, RR 1.09 (95% CI:0.70-1.70) for GnRH agonist versus dual trigger and 0.34 (95% CI:0.17-0.67) for GnRH agonist versus double trigger and RR 0.31 (95%CI:0.16-0.60) for double versus dual trigger. Dual trigger demonstrated the highest SUCRA (85.1%), indicating superior efficacy for clinical pregnancy rates. For LBR, while connectivity was limited, the RR was 1.31 (95% CI: 1.00-1.70) for dual versus hCG trigger, and RR 1.60 (95% CI: 1.05-2.43) for dual versus GnRH agonist trigger. OHSS rates were significantly lower with the GnRH agonist compared to hCG trigger (RR 0.56, 95% CI: 0.19-1.75). There were no randomized controlled trials reporting OHSS rates with the use of dual or double trigger. No significant differences were observed in the number of oocytes retrieved, mature oocytes, or miscarriage rates among the trigger protocols. CONCLUSION AND RELEVANCE The findings indicate that there is no evidence to suggest that using GnRH agonist, dual, or double protocols is superior to hCG trigger in improving clinical pregnancy rates. While live birth rates may benefit from dual trigger, results are limited by available RCTs. Larger, multicentre trials are needed for further evaluation of live birth rates and understanding of long-term outcomes.

中文翻译：

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在正常反应者的 IVF 治疗中触发卵母细胞成熟：系统评价和网络荟萃分析。


目的 比较 hCG、GnRH 激动剂、双重和双重触发因素在接受卵巢刺激和 IVF 设计的预测正常反应者中的疗效和安全性： 随机对照试验 （RCT） 的系统评价和网络荟萃分析。数据来源 截至 2023 年 12 月在 PubMed、MEDLINE、EMBASE、临床试验注册库和 Cochrane 系统综述数据库中编入索引的 RCT。研究筛选和综合纳入了 12 项高完整性 RCT，包括 1,931 名女性，这些试验将 hCG 触发与 GnRH 激动剂触发、双重触发和双重触发进行了比较。使用 STATA 16 版进行统计分析。主要结局 主要结局包括临床妊娠率 （CPR）、活产率 （LBR）、卵母细胞数量、成熟卵母细胞数量、流产率和卵巢过度刺激综合征 （OHSS） 发生率。结果 CPR 的网络荟萃分析为 hCG 与 GnRH 激动剂触发的相对风险 （RR） 1.13 （95% 置信区间 （CI）：0.80-1.60），hCG 与双触发的 RR 1.23 （95% CI：0.92-1.65），hCG 与双触发的 RR 0.38 （95% CI：0.21-0.69），GnRH 激动剂与双触发的 RR 1.09 （95% CI：0.70-1.70），GnRH 激动剂与双触发的 RR 0.34 （95% CI：0.17-0.67），双触发与双触发的 RR 0.31 （95% CI：0.16-0.60）。双触发显示出最高的 SUCRA （85.1%），表明对临床妊娠率具有卓越的疗效。对于 LBR，虽然连接性有限，但双重与 hCG 触发的 RR 为 1.31 （95% CI： 1.00-1.70），双重与 GnRH 激动剂触发的 RR 为 1.60 （95% CI： 1.05-2.43）。与 hCG 触发因素相比，GnRH 激动剂的 OHSS 发生率显著降低 （RR 0.56,95% CI： 0.19-1.75）。 没有随机对照试验报告使用双触发或双触发的 OHSS 发生率。在触发方案之间，未观察到取卵母细胞数量、成熟卵母细胞或流产率的显著差异。结论和相关性 研究结果表明，没有证据表明使用 GnRH 激动剂、双联或双联方案在提高临床妊娠率方面优于 hCG 触发因素。虽然活产率可能受益于双重触发，但结果受到现有 RCT 的限制。需要更大规模的多中心试验来进一步评估活产率和了解长期结局。