Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation.
Author(s): Filicori M, Cognigni GE, Gamberini E, Parmegiani L, Troilo E, Roset B
Affiliation(s): Reproductive Endocrinology Center, University of Bologna, Bologna, Italy. email@example.com
Publication date & source: 2005-08, Fertil Steril., 84(2):394-401.
Publication type: Randomized Controlled Trial
OBJECTIVE: To prove that low-dose hCG alone can be clinically used to replace FSH-containing gonadotropins to complete controlled ovarian hyperstimulation (COH). DESIGN: Controlled, prospective, randomized study. SETTING: Academic center. PATIENT(S): Infertile patients who are candidates for assisted reproduction. INTERVENTION(S): Patients received  recombinant FSH or hMG throughout COH (group A);  ovarian priming with recombinant FSH/hMG followed by low-dose hCG (200 IU/day) alone (group B). MAIN OUTCOME MEASURE(S): Medication consumption; daily serum and follicular fluid (FF) measurements of LH, FSH, hCG, E2, P, T, and androstenedione (A); number and size of follicles; intracytoplasmic sperm injection (ICSI) outcome. RESULT(S): In group B:  duration and dose of recombinant FSH/hMG administration were reduced;  preovulatory serum hCG, E2, and T were higher, whereas FSH was lower;  FF hCG, E2, T levels, and E2/T, E2/A, and E2/P ratios were higher, whereas A was lower;  small but not large preovulatory follicles were reduced;  fertilization rates were higher; and  serum and FF P levels, and ICSI outcome did not differ. CONCLUSION(S): Low-dose hCG alone in the late COH stages:  reduced recombinant FSH/hMG consumption whereas ICSI outcome was comparable to traditional COH regimens;  stimulated follicle growth and maturation independent of FSH administration;  was associated with a reduced number of small preovulatory follicles;  did not cause premature luteinization;  resulted in a more estrogenic intrafollicular environment.