Efficacy of Low Dose HCG on Oocyte Maturity for Ovarian Stimulation in Poor Responder Women Undergoing Intracytoplasmic Sperm Injection Cycle: a Randomized Controlled Trial

Overview

Journal J Assist Reprod Genet

Publisher Springer

Specialties Genetics
Reproductive Medicine

Date 2012 Sep 8

PMID 22956348

Citations 3

Authors

Tahereh Madani

Ladan Mohammadi Yeganeh

Shabnam Khodabakhshi

Mohammad Reza Akhoond

Fatemeh Hasani

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the effect of late follicular administration of low dose hCG on oocyte maturity in poor responding women undergoing intracytoplasmic sperm injection (ICSI).

Materials And Methods: This prospective randomized pilot trial was performed on 73 poor responders undergoing ICSI, in Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran. All eligible patients underwent a GnRH-a long protocol and were randomly allocated into three study groups for ovarian stimulation: groupA received recombinant FSH alone, group B received recombinant FSH supplemented by 100 IU hCG. Group C received recombinant FSH supplemented by 200 IU hCG. The main endpoint was the number of metaphase II oocytes retrieved.

Results: Of 78 poor responding patients entered to this study, 73 women were considered eligible for enrolment. Of these, 26 women were allocated to receive only recombinant FSH, 24 patients allocated to receive recombinant FSH and 100 IU hCG and 23 patients were assigned to receive recombinant FSH and 200 IU hCG. Number of oocytes retrieved were significantly higher in group B compared to group A (6.5 ± 3.3 versus 4.0 ± 2.3; P = .03). Other cycle and clinical outcomes were comparable between three groups.

Conclusions: The present study demonstrated that adding 100 IU hCG to rFSH in a GnRH agonist cycle in poor responders improve response to stimulation whereas the number of metaphase II oocytes remains comparable between groups. The existence of a possible trend toward higher mature oocytes and lower total dosage rFSH in patients received 100 or 200 IU hCG is probably due to the small sample size that means further large clinical trials in a more homogenous population is required (clinical trial registration number; NCT01509833).

Citing Articles

Effects of 100 IU versus 150 IU hCG supplementation on oocyte and embryo quality in patients aged ≥ 35 years: a propensity score-matched analysis.

Huong N, Thuy T, Anh P, Long H, Thang L, Ngoc V Int J Med Sci. 2025; 22(4):982-989.

PMID: 39991766 PMC: 11843143. DOI: 10.7150/ijms.106965.

Type and dose of gonadotropins in poor ovarian responders: does it matter?.

Boudry L, Racca A, Tournaye H, Blockeel C Ther Adv Reprod Health. 2021; 15:26334941211024203.

PMID: 34263173 PMC: 8243085. DOI: 10.1177/26334941211024203.

The effect of human chorionic gonadotrophin contained in human menopausal gonadotropin on the clinical outcomes during progestin-primed ovarian stimulation.

Zhu X, Ye J, Fu Y, Ai A, Cai R, Wang Y Oncotarget. 2017; 8(50):87340-87352.

PMID: 29152085 PMC: 5675637. DOI: 10.18632/oncotarget.20508.

Poor ovarian reserve.

Jirge P J Hum Reprod Sci. 2016; 9(2):63-9.

PMID: 27382229 PMC: 4915288. DOI: 10.4103/0974-1208.183514.

References

Laml T, Obruca A, Fischl F, Huber J . Recombinant luteinizing hormone in ovarian hyperstimulation after stimulation failure in normogonadotropic women. Gynecol Endocrinol. 1999; 13(2):98-103. DOI: 10.3109/09513599909167540. View

Keay S, Barlow R, Eley A, MASSON G, Anthony F, Jenkins J . The relation between immunoglobulin G antibodies to Chlamydia trachomatis and poor ovarian response to gonadotropin stimulation before in vitro fertilization. Fertil Steril. 1998; 70(2):214-8. DOI: 10.1016/s0015-0282(98)00145-9. View

Ferraretti A, La Marca A, Fauser B, Tarlatzis B, Nargund G, Gianaroli L . ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011; 26(7):1616-24. DOI: 10.1093/humrep/der092. View

Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Hassani F, Movaghar B . Vitrification versus slow freezing gives excellent survival, post warming embryo morphology and pregnancy outcomes for human cleaved embryos. J Assist Reprod Genet. 2009; 26(6):347-54. PMC: 2729856. DOI: 10.1007/s10815-009-9318-6. View

Filicori M, Cognigni G, Gamberini E, Parmegiani L, Troilo E, Roset B . Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation. Fertil Steril. 2005; 84(2):394-401. DOI: 10.1016/j.fertnstert.2005.02.036. View

Keay S, Liversedge N, Mathur R, Jenkins J . Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol. 1997; 104(5):521-7. DOI: 10.1111/j.1471-0528.1997.tb11525.x. View

Drakakis P, Loutradis D, Beloukas A, Sypsa V, Anastasiadou V, Kalofolias G . Early hCG addition to rFSH for ovarian stimulation in IVF provides better results and the cDNA copies of the hCG receptor may be an indicator of successful stimulation. Reprod Biol Endocrinol. 2009; 7:110. PMC: 2770481. DOI: 10.1186/1477-7827-7-110. View

Padhy N, Gupta S, Mahla A, Latha M, Varma T . Demographic characteristics and clinical profile of poor responders in IVF / ICSI: A comparative study. J Hum Reprod Sci. 2011; 3(2):91-4. PMC: 2970798. DOI: 10.4103/0974-1208.69343. View

Ferraretti A, Gianaroli L, Magli M, DAngelo A, Farfalli V, Montanaro N . Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques. Fertil Steril. 2004; 82(6):1521-6. DOI: 10.1016/j.fertnstert.2004.06.041. View

10.

Fabregues F, Creus M, Penarrubia J, Manau D, Vanrell J, Balasch J . Effects of recombinant human luteinizing hormone supplementation on ovarian stimulation and the implantation rate in down-regulated women of advanced reproductive age. Fertil Steril. 2006; 85(4):925-31. DOI: 10.1016/j.fertnstert.2005.09.049. View

11.

Matorras R, Prieto B, Exposito A, Mendoza R, Crisol L, Herranz P . Mid-follicular LH supplementation in women aged 35-39 years undergoing ICSI cycles: a randomized controlled study. Reprod Biomed Online. 2011; 22 Suppl 1:S43-51. DOI: 10.1016/S1472-6483(11)60008-4. View

12.

Kolibianakis E, Kalogeropoulou L, Griesinger G, Papanikolaou E, Papadimas J, Bontis J . Among patients treated with FSH and GnRH analogues for in vitro fertilization, is the addition of recombinant LH associated with the probability of live birth? A systematic review and meta-analysis. Hum Reprod Update. 2007; 13(5):445-52. DOI: 10.1093/humupd/dmm008. View

13.

Filicori M, Fazleabas A, Huhtaniemi I, Licht P, Rao C, Tesarik J . Novel concepts of human chorionic gonadotropin: reproductive system interactions and potential in the management of infertility. Fertil Steril. 2005; 84(2):275-84. DOI: 10.1016/j.fertnstert.2005.02.033. View

14.

Loutradis D, Elsheikh A, Kallianidis K, Drakakis P, Stefanidis K, Milingos S . Results of controlled ovarian stimulation for ART in poor responders according to the short protocol using different gonadotrophins combinations. Arch Gynecol Obstet. 2003; 270(4):223-6. DOI: 10.1007/s00404-003-0544-3. View

15.

Caglar G, Asimakopoulos B, Nikolettos N, Diedrich K, Al-Hasani S . Recombinant LH in ovarian stimulation. Reprod Biomed Online. 2005; 10(6):774-85. DOI: 10.1016/s1472-6483(10)61123-6. View

16.

Veeck L . Oocyte assessment and biological performance. Ann N Y Acad Sci. 1988; 541:259-74. DOI: 10.1111/j.1749-6632.1988.tb22263.x. View

17.

Filicori M, Cognigni G, Taraborrelli S, Spettoli D, Ciampaglia W, de Fatis C . Low-dose human chorionic gonadotropin therapy can improve sensitivity to exogenous follicle-stimulating hormone in patients with secondary amenorrhea. Fertil Steril. 1999; 72(6):1118-20. DOI: 10.1016/s0015-0282(99)00426-4. View

18.

Shoham Z, Smith H, Yeko T, OBrien F, Hemsey G, ODea L . Recombinant LH (lutropin alfa) for the treatment of hypogonadotrophic women with profound LH deficiency: a randomized, double-blind, placebo-controlled, proof-of-efficacy study. Clin Endocrinol (Oxf). 2008; 69(3):471-8. DOI: 10.1111/j.1365-2265.2008.03299.x. View

19.

. Recombinant human luteinizing hormone (LH) to support recombinant human follicle-stimulating hormone (FSH)-induced follicular development in LH- and FSH-deficient anovulatory women: a dose-finding study. The European Recombinant Human LH Study Group. J Clin Endocrinol Metab. 1998; 83(5):1507-14. DOI: 10.1210/jcem.83.5.4770. View

20.

Filicori M, Cognigni G, Taraborrelli S, Parmegiani L, Bernardi S, Ciampaglia W . Intracytoplasmic sperm injection pregnancy after low-dose human chorionic gonadotropin alone to support ovarian folliculogenesis. Fertil Steril. 2002; 78(2):414-6. DOI: 10.1016/s0015-0282(02)03243-0. View