Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on pregnancy rate: A prospective randomized study

Abstract

Background:Human chorionic gonadotropin (hCG) as the most important factor to controlled implantation is one of the early embryonic signals in primates that is secreted by the embryo before its implantation. This study was designed to assess the effects of intrauterine injection of hCG before the embryo transfer in an in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle on pregnancy rate in infertile patients.Materials and Methods:This randomized study was done on 100 infertile patients in two groups: intervention group received injection of 700 IU of intrauterine hCG 10 min before embryo transfer and control group did not receive hCG. The pregnancy rate was tested 2 weeks after embryo transfer, and if the pregnancy test was positive, a transvaginal ultrasound was performed 3 weeks later to search for signs of pregnancy, such as the presence of a gestational sac, embryo, and fetal heart rate, and confirmed as successful pregnancy.Results:Pregnancy test was positive in 13 (28.6%) of 46 patients in hCG group and in control group was positive in 6 (12.5%) of 48 patients. The pregnancy rate between hCG group and control group was not significantly different (P = 0.54). The pregnancy rate in hCG group with IVF fertilization was 20.8% and in their controls was 7.4% (P = 0.51). The pregnancy rate in hCG group with ICSI fertilization was 36.4% and in their controls was 19% (P = 0.16).Conclusion:The intrauterine injection of 700 IU of hCG before embryo transfer improved pregnancy rate compared to control group but was not significantly different.

The Effect of Intrauterine Administration of Human Chorionic Gonadotropin (hCG) Before Embryo Transfer During Assisted Reproductive Cycles: a Meta-Analysis of Randomized Controlled Trials

“…As shown in Fig. 2 b , all included studies 3 , 9 – 14 , 17 , 18 , 19 , 20 , 21 reported the clinical pregnancy rate, and significant heterogeneity was observed among the studies (I 2 = 73%, p < 0.0001). A random effects model analysis of the pooled data revealed a statistically significant increase in the clinical pregnancy rate in the hCG group, compared with the control group (RR = 1.33; 95% CI: 1.12 – 1.58).…”

“…Of the 22 articles that met the initial selection criteria, 10 were excluded after a careful reading of the full text. Finally, this meta-analysis included 12 RCTs 3 , 9 , 10 , 11 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 involving 3241 patients. The characteristics of each included study are listed in Table 1 .…”

“…Another study demonstrated that the intrauterine injection of hCG before ET improved the implantation and pregnancy rates during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles 3 . Still, the reported effects of hCG intrauterine injection before embryo transfer during assisted reproduction have not been completely consistent 9 , 10 , 11 , 12 , 13 , 14 .…”

Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures

“…All the above established an evidence base for clinical trials. A moderate number of clinical trials have been performed so far (summarized in Table 2 ), with the majority of them being randomized controlled trials ( Mansour et al, 2011 ; Hong et al, 2014 ; Santibañez et al, 2014 ; Zarei et al, 2014 ; Aaleyasin et al, 2015 ; Wirleitner et al, 2015 ; Dehghani Firouzabadi et al, 2016 ; Navali et al, 2016 ; Huang et al, 2017a ; Mostajeran et al, 2017 ; Boonsuk et al, 2018 ; Hafezi et al, 2018 ; Laokirkkiat and Thanaboonyawat, 2019 ). Despite the anticipation for solid evidence, an in-depth evaluation reveals high heterogeneity due to different methodologies applied.…”

Investigating the Optimal Time for Intrauterine Human Chorionic Gonadotropin Infusion in Order to Improve IVF Outcome: A Systematic Review and Meta-Analysis

“…The study concluded that 500 IU of hCG in 1 mL of culture media mirrors the ideal concentration to be injected into the uterine cavity, about 7 minutes prior to ET, promising enhanced pregnancy rates (10). Hitherto, several prospective studies have advocated the benefit of hCG administration as a valid option for improvement of pregnancy rates during IVF/ICSI cycles (6,(11)(12)(13). In contrast, other studies have reported no positive effect of this approach with respect to pregnancy rates, and particularly for cases involving blastocyst ET (14,15).…”