Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF

Gomaa, Hala; Casper, Robert F.; Esfandiari, Navid; Chang, Paul; Bentov, Yaakov

doi:10.1186/1477-7827-10-55

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…In that setting, Partsinevelos et al reported significantly improved pregnancy rates in patients who received pre-treatment with hCG additionally to FSH compared to FSH alone in the subgroup of patients aged ≥35 years (=0.002) [9]. This is in accordance with respective studies in the field indicating a beneficial effect of addition of low dose hCG to FSH during COS concerning mature oocytes, fertilization rates, and number of frozen embryos for patients 40 years or older [17].…”

Section: Efficacy Of Hcg In Cossupporting

confidence: 61%

Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques

Prodromidou

Anagnostou

Mavrogianni

et al. 2021

Cureus

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A variety of protocols have evaluated the use of several forms of gonadotropins in controlled ovarian stimulation (COS). We aim to review the evolving trends on the use of gonadotropins human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) over time and their combinations in COS for patients who undergo assisted reproductive techniques (ART) protocols. A meticulous search of three electronic databases was performed for articles published in the field up to September 2020. The administration of hCG seems a promising alternative to conventional modalities for COS related to the enhancement of LH activity. The use of gonadotropins was associated with significantly elevated pregnancy rates that ranged from 20.8% to 46.2%. However, the currently available outcomes with regards to oocytes retrieved, number of embryos are still conflicting. A potential beneficial effect was observed by the majority of the studies in terms of the number of embryos and implantation rates, which is, however, highly affected by the type of protocol used (gonadotropin-releasing hormone [GnRH] agonist or antagonist). Further studies are warranted to elucidate the exact pathways of action of gonadotropins in controlled ovarian stimulation to attain the optimal effect.

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Section: Efficacy Of Hcg In Cossupporting

confidence: 61%

Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques

Prodromidou

Anagnostou

Mavrogianni

et al. 2021

Cureus

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“…The treatment groups consisted of 88 women with stimulation with recombinant FSH in combination with hCG and 99 women with FSH-stimulation alone. The addition of hCG resulted in a significant increased number of retrieved mature and fertilized oocytes as well as in significant higher estradiol levels at the day of hCG administration in women aged 40 years and older [16].…”

Section: Discussionmentioning

confidence: 99%

“…A potential benefit from the combination of hCG and recFSH for IVF/ICSI cycles in older infertile women was postulated [16]. In this retrospective case-control (RCT) study Canadian women were stimulated in a ''long'' GnRH-agonist protocol.…”

Section: Discussionmentioning

confidence: 99%

Successful controlled ovarian stimulation despite elevated hCG levels after first-trimester abortion in the context of fertility preservation

Goeckenjan¹,

Rösner²,

Tóth³

et al. 2013

Gynecological Endocrinology

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Fertility preservation prior to gonadotoxic chemotherapy by cryopreservation of the ovarian tissue and controlled ovarian stimulation can be effective immediately after induced abortion in the first trimenon. In a reproductive endocrinology and infertility unit of a tertiary care university-based medical centre (University Hospital of Heidelberg) a 37-year-old women with breast cancer was counseled for fertility preservation. Cryopreservation of ovarian tissue, followed by ovarian stimulation for planned intracytoplasmatic sperm injection (ICSI), transvaginal oocyte aspiration and cryopreservation of fertilized eggs was performed in spite of persistently elevated human chorionic gonadotropin (hCG)-levels after induced abortion. Twenty-four fertilized oocytes with a fertilization rate of 92% were cryopreserved. Ovarian stimulation and oocyte cryopreservation can be successfully performed with good results immediately after miscarriage, despite persistent high hCG-levels.

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“…This observation is consistent with our clinical experience that doses of FSH above 300 IU per day are unlikely to increase follicular response in older women or previous poor responders, and only adjunctive measures are likely to be of help in increasing oocyte yield. These include sensitizing the follicles using androgens prior to ovarian stimulation [11] or by adding LH or hCG to recFSH during ovarian stimulation [12]. Alternatively, if the FSH serum concentration on CD7 is less than 22 IU/L, there may be a place for increasing FSH dose if follicular response is less than desired.…”

Section: Discussionmentioning

confidence: 99%

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Bentov

Burstein

Firestone

et al. 2013

Reprod Biol Endocrinol

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BackgroundWhen stimulating a patient with poor ovarian response for IVF, the maximal dose of gonadotropins injected is often determined by arbitrary standards rather than a measured response. The purpose of this study was to determine if serum FSH concentration during an IVF stimulation cycle reflects follicular utilization of FSH and whether serum FSH values may inform dose adjustments of exogenous FSH.MethodsIn this retrospective cross sectional study we studied 155 consecutive IVF cycles stimulated only with recombinant human FSH. We only included long GnRH agonist protocols in which endogenous FSH levels were suppressed. We correlated the serum concentration of cycle day (CD) 7 FSH with the number of oocytes retrieved, cleaving embryos and pregnancy rate.ResultsWe found that a CD7 FSH concentration above 22 IU/L was associated with poor response regardless of the daily dose of FSH injected and a lower pregnancy rate.ConclusionsWe concluded that CD7 FSH concentration during stimulation could be used to guide FSH dosing in poor responders. If the CD7 FSH concentration is above 22 IU/L increasing the dose of FSH in an attempt to recruit more growing follicles is unlikely to be successful.

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Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF

Cited by 11 publications

References 30 publications

Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques

Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques

Successful controlled ovarian stimulation despite elevated hCG levels after first-trimester abortion in the context of fertility preservation

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

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