Efficacy of dual triggering in poor ovarian responders defined according to Bologna and POSEIDON criteria: a systematic review with meta-analysis

PURPOSE: To compare dual triggering versus hCG-only triggering in poor responders undergoing controlled ovarian stimulation with a GnRH antagonist protocol in ART cycles. METHODS: A systematic review and meta-analysis was performed. The primary outcome was the number of mature oocytes (MII). The number of oocytes retrieved, clinical pregnancy, and miscarriage rates were analyzed as secondary outcomes. Subgroup analyses were conducted according to the Bologna and POSEIDON classifications. RESULTS: Ten studies were included. Dual triggering significantly increased the number of retrieved and mature oocytes in patients classified according to the Bologna criteria, but not in those classified by the POSEIDON criteria. Age-related differences across studies appeared to influence the efficacy of dual triggering. A borderline improvement in clinical pregnancy rates was observed among Bologna-defined patients. Miscarriage rates did not differ significantly between the groups. CONCLUSIONS: Dual triggering appears to improve oocyte yield and maturity in Bologna-defined patients, but this effect is unlikely to apply uniformly across all phenotypes. Persistent heterogeneity in poor responder definitions limits the understanding of the benefits of dual triggering in this population. Well-designed prospective studies with rigorous phenotypic stratification are warranted to identify which patients are most likely to benefit from dual triggering.