Do intrauterine injection of human chorionic gonadotropin (hCG) before embryo transfer increases implantation and pregnancy rates in patients undergoing in vitro fertilization?

Rebolloso, M.M.; Leon, J; Vega, Pedro Galache; Santos-Haliscak, R.; Diaz-Spindola, P.; Vega, O. Gonzalez

doi:10.1016/j.fertnstert.2013.07.1082

Cited by 4 publications

(4 citation statements)

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“…Further, in line with several previous reports, we did not observe an increase in miscarriages in the hCG groups when compared to controls. These results confirm previous findings [ 19 – 22 , 27 ]. In conclusion, this large prospective randomised study could not find any beneficial effect of intrauterine hCG injection (500 IU) in blastocyst transfers.…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, in line with our results, the study of Rebolloso and colleagues did not observe any improvement in clinical outcome after administration of hCG [ 22 ]. This randomised study performed on a small cohort, including 38 patients who received 500 IU hCG and 83 patients in the control group.…”

Section: Discussionsupporting

confidence: 91%

“…They found that application of 500 IU hCG prior to cleavage stage embryo transfer (ET) significantly improves pregnancy rates (PR) [ 19 ]. Similar results were reported in further studies on cleavage stage ETs [ 12 , 20 – 22 ]. However, in blastocyst transfers, a beneficial effect of intrauterine hCG administration could only be confirmed for low-quality blastocysts [ 12 ].…”

Section: Introductionsupporting

confidence: 91%

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Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study

Wirleitner

Schuff

Vanderzwalmen

et al. 2015

Reprod Biol Endocrinol

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BackgroundSuccessful embryo implantation depends on a well-timed maternal-embryonic crosstalk. Human chorionic gonadotropin (hCG) secreted by the embryo is known to play a key role in this process and to trigger a complex signal transduction cascade allowing the apposition, attachment, and invasion of the embryo into the decidualized uterus. Production of hCG was reported to be dependent on blastocyst quality and several articles suggested that intrauterine hCG injection increases pregnancy and implantation rates in IVF patients. However, no study has as yet analysed birth rates as final outcome. Our objective was to determine whether clinical outcome after blastocyst transfer can be improved by intrauterine injection of hCG and whether this is dependent on blastocyst quality.MethodsA prospective randomised study was conducted in two settings. In cohort A, hCG application was performed two days before blastocyst transfer. In cohort B, the administration of hCG occurred just prior to embryo transfer on day 5. For both cohorts, patients were randomised to either intrauterine hCG application or to the control group that received culture medium. Clinical outcome was analysed according to blastocyst quality of transferred embryos.ResultsThe outcome of 182 IVF-cycles (cohort A) and 1004 IVF-cycles (cohort B) was analysed. All patients received a fresh autologous blastocyst transfer on day five. Primary outcomes were pregnancy rates (PR), clinical pregnancy rates (cPR), miscarriage rates (MR), and live birth rates (LBR). No improvement of clinical outcome after intrauterine hCG administration on day 3 (cohort A) or day 5 (cohort B) was found, independently of blastocyst quality transferred. The final outcome in cohort A: LBR after transfer of top blastocysts was 50.0 % with hCG and 53.3 % in the control group. With non-top blastocysts, LBR of 17.1 % (hCG) and 18.2 % (control) were observed (n.s.). In cohort B, LBR with top blastocysts was 53.3 % (hCG) and 48.4 % (control), with non-top blastocysts it came to 28.7 % (hCG) and 35.0 % (control). The differences between the groups were statistically not significant. Furthermore, we investigated a possible benefit of hCG administration in correlation with female age. In both age groups (<38 years and ≥ 38 years) we found similar LBR after treatment with hCG vs. medium. A LBR of 47.1 % vs. 48.7 % was obtained in the younger group and 26.6 % vs. 30.8 % in the older group.ConclusionsIn contrast to previous studies indicating a substantial benefit from intrauterine hCG application in cleavage stage embryo transfers, in our study we could not find any evidence for improvement of clinical outcome in blastocyst transfer cycles, neither with top nor with non-top quality morphology.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 91%

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Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study

Wirleitner

Schuff

Vanderzwalmen

et al. 2015

Reprod Biol Endocrinol

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“…In Rebolloso et al study, injection of urinary hCG before fresh ET showed no positive effect on implantation and ongoing pregnancy results and only multiple pregnancies increased. Their study cannot be relied upon due to its small sample size (10). A systemic review and meta-analysis conducted by Ye et al in 2015 showed that intrauterine hCG injection prior to ET significantly increased the rates of biochemical, clinical and ongoing pregnancy compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intrauterine Injection of Human Chorionic Gonadotropin Before Frozen-Thawed Embryo Transfer on Implantation and Clinical Pregnancy Rate: A Randomized Controlled Trial

Hosseini¹,

Farzadi²,

Abdollahi³

et al. 2016

IJWHR

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Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

Craciunas

Tsampras²,

Coomarasamy

et al. 2016

Cochrane Database of Systematic Reviews

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The pregnancy outcome for cleavage-stage ETs using an IC-hCG dose of 500 IU or greater is promising. However, given the small size and the variable quality of the trials and the fact that the positive finding was from a subgroup analysis, the current evidence for IC-hCG treatment does not support its use in assisted reproduction cycles. A definitive large clinical trial with live birth as the primary outcome is recommended. There was no evidence that miscarriage was influenced by intrauterine hCG administration, irrespective of embryo stage at transfer or dose of IC-hCG. There were too few events to allow any conclusions to be drawn with regard to other complications.

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Do intrauterine injection of human chorionic gonadotropin (hCG) before embryo transfer increases implantation and pregnancy rates in patients undergoing in vitro fertilization?

Cited by 4 publications

References 0 publications

Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study

Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study

Effect of Intrauterine Injection of Human Chorionic Gonadotropin Before Frozen-Thawed Embryo Transfer on Implantation and Clinical Pregnancy Rate: A Randomized Controlled Trial

Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

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