Does high dose hCG triggering bring favorable outcomes
in IVF cycles with GnRH antagonist protocol?
J. Bae, H. Koo, N. Sung, Y. Hwang, S. Cha, I. Song, H. Kim, M. Koong, I. Kang, E. Min, K. Yang
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology,
Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
Res ul ts
I nt roduction
Table 1. Comparison of Clinical characteristics among three groups.
Human Chorionic Gonadotropin (hCG)
9 HCG is as a therapeutic analog of LH, they stimulate the same
receptor of LH and play the same role of LH such as resumption
of meiosis, oocyte maturation and luteinization.
Yen et al., J Clin Endocrinol Metab., 1968
Diczfalusy et al., Hum Reprod., 1988
9 HCG modulated several endometrial parameters; endometrial
differentiation (IGFBP-1), angiogenesis (VEGF), implantation
(LIF, M-CSF) and tissue remodeling (MMP-9). That increases
the invasive potential of trophoblast-derived cells.
Licht et al., Reprod Biol., 2001
Tapia et al., Hum Reprod., 2013
9 The plasma metabolic clearance rate of hCG is slower than that
of LH. And between urinary and recombinant hCG, u-hCG has
slightly longer half-life than r-hCG. The calculated initial halflife of r-hLH, r-hCG and u-hCG is 0.8 㫧 0.2, 4.7 㫧 0.8 and 5.5 㫧
1.3 hours.
Le Cotonnec JY et al., Fertil Steril., 1998
Davar R et al., Taiwan J Obstet Gynecol 2010
Trinchard-Lugan Khan A et al., Reprod Biomed Online 2002
Obj ect ive
The
h purpose off this
h study
d is to evaluate
l
whether
h h increased
i
d hCG
injection can brings more favorable IVF outcomes.
Ma teri al s a nd Met hods
z Prospective study
January, 2013 ~ February, 2014
Fresh IVF-ET cycles with GnRH antagonist protocol
r-hCG
250 ঋ
hCG triggering
with
hCG triggering
with
r-hCG 250 ໌
N=301
r-hCG 500 ໌
N=200
hCG triggering
with
u-hCG 10,000 IU
N=98
z Outcome Measures
• Serum hCG level of OPU day
• Rate of oocyte maturation, fertilization
• Rate of implantation, biochemical pregnancy, clinical
pregnancy
• Rate of OHSS incidence
z Statistical analysis
• SPSS software version 12.0
• Oneway ANOVA and Chi-Square tests were used for statistical
analysis. P values < 0.05 were considered as significant.
Urinary-hCG
10,000 IU
P-value
Age (year)
34.1 㫧 3.1
34.3 㫧 3.0
33.9 㫧 3.3
NS
BMI (kg/䋛)
21.1 㫧 2.3
20.9 㫧 2.5
21.2 㫧 2.6
NS
Number of previous
IVF attempt
1.6 㫧 0.9
1.6 㫧 1.0
1.7 㫧 1.3
NS
AMH (ng/mL)
2.77 㫧 2.48
2.67 㫧 2.46
2.35 㫧 2.42
NS
Basal FSH (mIU/mL)
7.35 㫧 2.42
7.45 㫧 2.31
7.66 㫧 2.47
NS
Basal LH (mIU/ml)
5.19 㫧 1.99
5.27 㫧 2.01
5.58 㫧 2.21
NS
Basal E2 (pg/mL)
36.89 㫧 16.18
37.15㫧 16.85
38.47 㫧 18.88
NS
9.4 㫧 1.4
9.4 㫧 1.5
9.6 㫧 1.3
NS
10.5 㫧 2.1
10.4 㫧 2.3
10.6 㫧 2.1
NS
Duration of
stimulation (day)
Endometrial
thickness of hCG
injected day (mm)
Table 2. Comparison of IVF outcomes among three groups.
r-hCG
250 ໌
r-hCG
500 ໌
Urinary-hCG
10,000 IU
P-value
Serum hCG level on
retrieval day (IU/mL)
78.86 ± 23.02
180.49 ± 59.00
244.55 ± 104.46
0.000
Number of retrieved
oocytes
13.2 ± 9.2
11.8 ± 7.8
12.4 ± 8.7
NS
Oocyte maturation
rate (%)
73.4 ± 19.3
77.1 ± 18.0
75.8 ± 20.9
NS
Fertilization rate (%)
70.5 ± 23.9
73.7 ± 22.9
73.2 ±23.3
NS
Good embryo rate (%)
45.5 ± 32.9
42.3 ± 32.7
43.0 ± 34.4
NS
Number of
transferred embryo
2.8 ± 0.9
2.8 ± 0.9
3.0 ± 0.9
NS
β hCG positive rate
46.3% (119/257)
53.9% (89/165)
61.2% (52/85)
0.031
20.2 ± 29.5
20.8 ± 27.3
24.8 ± 26.4
NS
Biochemical
pregnancy rate
7.0% (18/257)
7.3% (12/165)
4.7% (4/85)
NS
Clinical pregnancy
rate
38.5% (99/257)
44.2% (73/165)
55.3% (47/85)
0.010
2.3% (7/301)
2.5% (5/200)
2% (2/98)
NS
Implantation rate (%)
Exclusion criteria : Previous IVF cycle number ≥ 4
Age ≥ 40 years
BMI ≥ 27 kg/m2
PCOS
r-hCG
500 ঋ
Rate of OHSS
incidence
Summary
¾ Th
There are no significant
i ifi
diff
difference iin the
h oocyte maturation
i rate,
fertilization rate, implantation rate, biochemical pregnancy rate
and OHSS incidence rate among three groups.
¾ Rate of β hCG positive and clinical pregnancy were significantly
higher in double dose hCG triggering groups than single dose hCG
triggering group.
Concl usi on
Increased dose of hCG for ovulation triggering in GnRH
antagonist IVF cycle seems to have advantageous roles for
achieve favorable outcomes.