The benefit of human chorionic gonadotropin supplementation throughout the secretory phase of frozen-thawed embryo transfer cycles

Ben‐Meir, Assaf; Aboo-Dia, Mushira; Revel, Ariel; Eizenman, Einat; Laufer, Neri; Simon, Alex

doi:10.1016/j.fertnstert.2009.02.027

Cited by 13 publications

(16 citation statements)

References 15 publications

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“…[ 37 ] and Ben-Meir et al . [ 38 ]. Both research groups observed that the subcutaneous administration of recombinant hCG in frozen-thawed ET cycles on the day of transfer does not have any advantages in terms of pregnancy and implantation rates.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Although hCG has been commercially available for a long time, a few human trials have addressed the value of hCG injection in ET. In a study by Ben-Meir et al [21], standard endometrial preparation with progesterone was compared with an additional 250 µg of subcutaneous recombinant hCG on the day of progesterone initiation, the day of ET, and 6 days later. Implantation and pregnancy rates did not differ between the two methods (14.9 vs. 12.7% and 32.2 vs. 28.2%, respectively, p > 0.05).…”

Section: Discussionmentioning

confidence: 99%

In vitro Fertilization Outcome following Embryo Transfer with or without Preinstillation of Human Chorionic Gonadotropin into the Uterine Cavity: A Randomized Controlled Trial

Aaleyasin

Aghahosseini

Rashidi

et al. 2014

Gynecol Obstet Invest

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Background: Intrauterine injection of human chorionic gonadotropin (hCG) at embryo transfer (ET) has been shown to improve the outcome of assisted reproductive techniques. The aim of this study was to confirm previous findings. Methods: In this randomized controlled trial, 483 infertile women who were candidates for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for the first time were randomly assigned to receive an intrauterine injection of 500 IU hCG or placebo (tissue culture media) before ET. The main outcome measures were implantation and clinical pregnancy rates. Results: Both the hCG-treated group (n = 240) and control group (n = 243) were similar at baseline in terms of demographic and obstetrical characteristics.There were significant differences between the two groups regarding the implantation rate (23.6 vs. 12.2%, p < 0.001), pregnancy rate (54.6 vs. 35.8%, p < 0.001), clinical pregnancy rate (50 vs. 32.1%, p < 0.001), ongoing pregnancy rate (15.3 vs. 9.2%, p < 0.001) and live delivery rate (14.3 vs. 8.4%, p < 0.001). The rate of fertilization and abortion rates were not statistically different. Conclusion: Intrauterine injection of hCG before ET improves implantation and pregnancy rates and may be considered an adjuvant in IVF/ICSI.

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“…They randomized recipients with low endogenous LH to receive hCG (5,000 U) or no hCG 2 days before egg retrieval in the egg donor and found that the addition of hCG was associated with an improvement in the endometrial thickness and in implantation rates. Subsequently, Ben-Meir et al (61) conducted a prospective randomized trial of 165 subjects undergoing frozen-thawed embryo transfer, randomized to receive three adjuvant hCG injections or no hCG throughout the luteal phase of an artificial cycle. However, they observed no difference between the groups in endometrial thickness or in pregnancy rates.…”

Section: Poorly Responsive Endometrium and Other Substancesmentioning

confidence: 99%

Hormonal induction of endometrial receptivity

Paulson

2011

Fertility and Sterility

187

134

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The benefit of human chorionic gonadotropin supplementation throughout the secretory phase of frozen-thawed embryo transfer cycles

Cited by 13 publications

References 15 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

In vitro Fertilization Outcome following Embryo Transfer with or without Preinstillation of Human Chorionic Gonadotropin into the Uterine Cavity: A Randomized Controlled Trial

Hormonal induction of endometrial receptivity

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