GnRH-Agonist for Luteal Phase Support Following Dual Trigger: A Proof-of-Concept Study

This study evaluated whether a gonadotropin-releasing hormone (GnRH) agonist can be effectively used for luteal phase support following a dual trigger in IVF. A total of 284 patients undergoing fresh embryo transfer were included: 116 received a dual trigger and 168 an hCG trigger. All patients received luteal support with Nafarelin nasal spray twice daily for two weeks, starting on the day of oocyte retrieval. Women in the dual trigger group were older (36.2 vs. 32.3 years, p <  0.01), had lower antral follicle counts (7.0 vs. 17.5, p = 0.03), and received higher total gonadotropin doses (3000 vs. 2041 IU, p <  0.01). There were no significant differences between groups in retrieved and mature oocytes, fertilization rate, or blastulation rate. Positive pregnancy rate (β-hCG ≥ 25 mIU/mL) was 46.6% in the dual trigger group and 41.1% in the hCG group, without a significant difference, with similar live birth and miscarriage rates. Logistic regression identified maternal age as a predictor of positive pregnancy (OR = 0.95; 95% CI: 0.90–0.99; p = 0.024), while trigger type was not. Propensity score matching confirmed comparable IVF and pregnancy outcomes between groups. These findings indicate that a dual trigger followed by luteal-phase GnRH agonist support yields IVF and pregnancy outcomes similar to an hCG trigger.