Efficacy of low dose hCG on oocyte maturity for ovarian stimulation in poor responder women undergoing intracytoplasmic sperm injection cycle: a randomized controlled trial

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; P0.03). 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.

Poor ovarian reserve

“…[ 56 ] Low-dose HCG supplementation or addition of pure HMG where HCG is the source of LH activity has shown some improvements in the oocyte yield. [ 57 58 ] Luteal start of FSH has been used to influence the recruitment of follicles without any reported clinical benefit. [ 59 ]…”

Strategies for Controlled Ovarian Stimulation in the Setting of Ovarian Aging

“…AE 2.1 vs. 5.2 AE 4.4 for control, 100 IU/d, and 200 IU/d hCG, respectively, p ¼ 0.16), clinical pregnancy (3/26, 4/24, and 5/23 for control, 100 IU/d, and 200 IU/d hCG, respectively, p ¼ 0.55), and live birth rates (3/26, 3/24, and 4/19 for control,100 IU/d, and 200 IU/d hCG, respectively, p ¼ 0.75) were similar between the groups 44. …”

“…While 26 women allocated to the control group received only rFSH, 24 and 23 women allocated to hCG groups received 100 or 200 IU/day hCG in addition, starting when the leading follicle reached 14 mm. 44 Even though women in the hCG arms tended to have more metaphase-two oocytes (3.4 AE 1.7 vs. 5.…”

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

“… 35 , 36 Conversely, some others failed to confirm these findings. 37 – 40 The concept of LH supplementation on OS is described below, but because there is no demonstrable superiority of one type of gonadotropin over another, combination therapy seems reasonless and expensive.…”