Is earlier administration of human chorionic gonadotropin (hCG) associated with the probability of pregnancy in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone (GnRH) antagonists? A prospective randomized trial.
Author(s): Kyrou D, Kolibianakis EM, Fatemi HM, Tarlatzis BC, Tournaye H, Devroey P
Affiliation(s): Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. email@example.com
Publication date & source: 2011-11, Fertil Steril., 96(5):1112-5. Epub 2011 Sep 15.
OBJECTIVE: To evaluate the association of timing of hCG administration and probability of pregnancy in patients stimulated with recombinant FSH/GnRH antagonists for IVF. DESIGN: Prospective randomized controlled clinical trial. SETTING: Dutch-speaking Free University of Brussels. PATIENT(S): One hundred twenty patients, aged <40 years, treated by IVF or intracytoplasmic sperm injection. INTERVENTION(S): Ovarian stimulation was achieved using recombinant FSH starting on day 2 of the menstrual cycle at a fixed dose. To inhibit premature LH surge, daily GnRH antagonist was used from day 6 of stimulation. Triggering of final oocyte maturation was performed using 10,000 IU of hCG. Patients were randomized to receive hCG either as soon as three or more follicles of size >/=16 mm were present on ultrasonography (early-hCG group) or 1 day after the above criterion was met (late-hCG group). MAIN OUTCOME MEASURE(S): Ongoing pregnancy rate. RESULT(S): Significant differences were observed between the early-hCG and the late-hCG group regarding E(2) (1,388 +/- 931 [mean +/- SD] vs. 2,040 +/- 1,231 pg/mL, respectively) and P (0.8 +/- 0.3 vs. 1.1 +/- 0.5 ng/mL, respectively) levels on the day of hCG administration and the number of metaphase II oocytes (9.2 +/- 7.1 vs. 6.1 +/- 4.9, respectively). No significant differences were observed between the early-hCG and the late-hCG group regarding positive hCG (46.2% vs. 50%, respectively) and ongoing pregnancy rates (34.6% vs. 40.7%, respectively). CONCLUSION(S): The current study provides evidence that earlier administration of hCG is not associated with the probability of pregnancy in cycles stimulated with recombinant FSH and GnRH antagonists. Copyright (c) 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.