Efficacy of Low-Dose Human Chorionic Gonadotropin (hCG) in a GnRH Antagonist Protocol

Abstract

Purpose:To examine the efficacy of low-dose hCG using a GnRH antagonist protocol. Methods: Prospective randomized study was performed at the Kyono Ladies Clinic. One hundred ninety-two women (<40 -years old, <3 previous cycles) were randomly assigned to GnRH agonist (buserelin) long protocol (LP, n = 66), GnRH antagonist (cetrorelix) with no low-dose hCG protocol (NhCGP, n = 63), or GnRH antagonist with low-dose hCG protocol (hCGP, n = 63). Results: The hCGP was associated with reduced total amounts of FSH, increased oocyte maturation rate, high-quality day 3 embryos rate, and number of frozen embryos. Ovarian hyperstimulation syndrome (OHSS) tended to be lower in the GnRH antagonist protocol. Pregnancy and implantation rates did not differ significantly between study groups. Conclusions: Daily low-dose hCG supplementation in the late follicular phase could improve the outcome in FSH based-GnRH antagonist protocol. This protocol, however, does require further modifications, including determination of the optimal doses for hCG and gonadotropin pretreatment.

Low-dose human chorionic gonadotropin may improve in vitro fertilization cycle outcomes in patients with low luteinizing hormone levels after gonadotropin-releasing hormone antagonist administration

“…The administration of hCG promotes follicular growth and oocyte maturation, thereby decreasing the amount of FSH needed for ovarian stimulation (12,14,15). We previously published a study that showed that hCG supplementation results in lower medication costs and similar pregnancy rates compared with FSH-only stimulation for GnRH-antagonist IVF cycles (14).…”

The Use of rLH, HMG and hCG in Controlled Ovarian Stimulation for Assisted Reproductive Technologies

“…A study by Filicori et al further demonstrated a significantly higher fertilization rate in patients receiving hCG versus rFSH only (74% versus 48%) (104). The remainder of the trials did not show any differences in outcomes with hCG with regards to fertilization, implantation, or pregnancy (105)(106)(107)109). These RCT total 614 patients and demonstrate that the addition of hCG results in higher estradiol levels and at least comparable ART outcomes to rFSH stimulation only.…”

“…All trials were initiated with rFSH only for stimulation with hCG added when the follicles were between 12-14mm in size. Five of the trials reported a significantly higher estradiol level on the day of hCG in patients randomized to receive hCG stimulation, with increases in estradiol ranging from 700-1500 pg/ml (104)(105)(106)(107)109). A study by Filicori et al further demonstrated a significantly higher fertilization rate in patients receiving hCG versus rFSH only (74% versus 48%) (104).…”

“…The dose of hCG utilized was 200IU per day in five trials and 250IU in another (104)(105)(106)(107)(108)(109). All trials were initiated with rFSH only for stimulation with hCG added when the follicles were between 12-14mm in size.…”

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

“…However, several other studies have shown better outcomes with additional LH in poor responders when GnRH-a short or long protocols were applied [40][41][42] whereas in the study of Bjercke et al and Hompes et al [43,44] in normal responders, the clinical outcomes were similar between rFSH and hMG groups. Some other trials demonstrated favorable treatment outcomes in an antagonist protocol in patients who received low dose hCG [18,45].…”