Dual versus Single Ovulation Triggers in In Vitro Fertilization and Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis

Background: Infertility remains a significant global health concern. Optimizing hormonal triggers, such as human chorionic gonadotropin (HCG) with or without gonadotropin-releasing hormone (GnRH) agonists, is crucial to enhance reproductive outcomes. We aim to evaluate and compare the reproductive success rates of dual trigger protocols (HCG + GnRH agonist) versus HCG alone in women undergoing assisted reproductive technologies (IVF/ICSI). Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published up to January 2025. Studies comparing reproductive outcomes in women undergoing IVF/ICSI who received either dual trigger (HCG + GnRH agonist) or HCG alone were included. Data were analyzed using RevMan version 5.4 and R Studio version 4.4.1. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, fertilization rate, and embryo quality metrics. Results: Seventeen studies with a total of 2,239 women were included: 1,118 in the dual trigger group and1,121in the HCG onlygroup.Thedualtriggergroupshowedsignificantlybetteroutcomesinterms of total oocytes retrieved, fertilized oocytes, follicles >15mm on trigger day, viable embryos, two pronuclei (2PN) formation, clinical pregnancy, biochemical pregnancy, live birth rate, good quality embryos, and fertilization rate. Conclusions Dual triggering with HCG and GnRH agonist appears to significantly enhance reproductive outcomes compared to HCG alone in women undergoing IVF or ICSI. These findings support the broader adoption of dual trigger protocols in assisted reproductive practice.