Materials and Methods: This prospective, randomized, single-blind trial included women diagnosed with DOR undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. Final oocyte maturation was triggered with one of the three regimens: human chorionic gonadotropin (hCG) alone, hCG combined with follicle-stimulating hormone (FSH), and hCG combined with GnRH agonist (dual-trigger). The primary outcome was the number of mature oocytes (metaphase II (MII stage)), and the secondary outcomes were the total number of oocytes retrieved, fertilization rate, embryo quality, and incidence of ovarian hyperstimulation syndrome (OHSS).

Results: Baseline demographic and stimulation characteristics were similar across groups. The hCG + GnRH agonist (dual-trigger) protocol resulted in significantly higher numbers of retrieved and mature oocytes compared with the hCG-alone and hCG + FSH triggers. Additionally, fertilization rates and the number of good-quality embryos were highest in the dual-trigger group. The co-trigger with hCG + FSH produced intermediate results, whereas hCG alone showed the lowest oocyte and embryo yields.

Conclusions: Dual triggering with hCG and a GnRH agonist improves oocyte maturation, fertilization outcomes, and embryo quality in women with DOR. This approach may represent a simple and effective modification of conventional antagonist cycles to enhance laboratory and potential clinical outcomes in this difficult-to-treat population. Further prospective trials are warranted to confirm its impact on pregnancy and live birth rates.