Oocyte maturation triggering in high responders in IVF treatment: a systematic review and network meta-analysis
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By
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April 2, 2026
Objective:
To compare and rank the efficacy and safety of four final oocyte maturation trigger strategies: human chorionic gonadotropin (hCG), gonadotropin-releasing hormone agonist (GnRHa), dual, and double trigger in predicted high responders undergoing IVF.
Key Findings:
- No significant differences in oocyte retrieval between GnRHa and hCG triggers (MD 1.08, 95% CI –1.06 to 3.22).
- GnRHa trigger significantly reduced the risk of moderate to severe OHSS compared to hCG (RR 0.23, 95% CI 0.07–0.82).
- Similar efficacy in terms of mature oocyte yield, clinical pregnancy rate, and miscarriage rate across trigger strategies.
Interpretation:
GnRHa, hCG, and dual triggers show similar efficacy in oocyte yield and pregnancy rates, but GnRHa offers a superior safety profile by significantly reducing the risk of OHSS.
Limitations:
- Limited to high-quality RCTs; larger multicenter RCTs are needed for live birth outcomes.
- Exclusion of oocyte donation cycles and trials lacking outcome data may limit generalizability and applicability of findings.
Conclusion:
GnRHa trigger is preferable for safety in high responders, while further studies are needed to explore the double trigger's role and its impact on live birth outcomes.
