Effect of dual trigger on reproductive outcome in low responders: a systematic PRISMA review and meta-analysis.

OBJECTIVE: Poor ovarian responders (PORs) pose a great challenge for fertility clinics worldwide. The aim of this study was to examine whether 'dual trigger' consisting of human chorionic gonadotropin (hCG) plus gonadotropin-releasing hormone agonist (GnRHa) is beneficial or not regarding implantation rate, pregnancy rate, and live birth rate for POR. METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Risk of bias was evaluated by the Newcastle-Ottawa scale or version 2 (NOS) of the Cochrane risk-of-bias tool for randomized trials (ROB2) independently by two authors. Furthermore, RevMan version 5.4 was used to analyze the extracted data and to create an inverse-weighted summary-odds ratio (OR). RESULTS: A total of 1390 studies were screened. Seven studies containing a total of 2474 POR were included. The pooled meta-analysis revealed a 1.62-fold increase in clinical pregnancy rate (OR = 1.62 [1.00, 2.62], p = .05) and a 2.65-fold increase in live birth rate (OR = 2.65 [1.66, 4.24], p < .0001) in the dual trigger group compared to hCG trigger. The pooled analysis showed no significant difference between the two groups regarding implantation rate (OR = 1.14 [0.93, 1.39], p = .21). CONCLUSIONS: The meta-analysis of this study indicates that dual trigger as finale oocyte maturation is advantageous compared to hCG trigger among POR. However, large-scale, high-quality, randomized controlled trials (RCT) are required to confirm this conclusion and fully address the magnitude of this effect.

Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis.

OBJECTIVE: To identify the risk of stillbirth from in vitro types of assisted reproductive technologies compared with spontaneous conception (SC), limited to singleton births. DESIGN: Systematic literature search and search chaining on online databases: PubMed, Embase, and Scopus. SETTING: Not applicable. PATIENT(S): Singleton pregnancies from in vitro fertilization (IVF) or fertilization by IVF and intracytoplasmic sperm injection (IVF-ICSI). INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Adjusted odds ratio for stillbirth or prevalence of stillbirth in case-control groups of IVF/IVF-ICSI singletons and SCs, respectively, in matched studies. RESULT(S): A total of 19 studies were included, and study quality was mixed. Ten studies qualified for inclusion to the meta-analysis, which revealed a significantly increased risk of stillbirth in IVF/IVF-ICSI compared with that in SC (odds ratio [95% confidence interval]: 1.82 [1.37-2.42]), and there was no evidence of publication bias. CONCLUSION(S): In vitro fertilization and IVF-ICSI treatment increases the risk of stillbirth compared with natural conception. CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO 216768.