Human choriogonadotropin prior to controlled ovarian stimulation and in vitro fertilization improves implantation, and pregnancy rates

Abstract

Purpose Our purpose was to retrospectively compare controlled ovarian stimulation(COH) in IVF cycles with administration of hCG on the day of menses (D1-hCG) with women not receiving hCG at day 1 of menses (Control). Methods Data on maternal age, endocrine profile, amount of rFSH required, embryo characteristics, implantation and pregnancy rates were recorded for comparison between D1-hCG (n=36) and Control (n=64). Results Dose of rFSH required to accomplish COH was significantly lower in D1-hCG. Following ICSI, more topquality embryos were available for transfer per patient in the D1-hCG and biochemical pregnancy rates per transfer were significantly higher in the D1-hCG. Significantly higher implantation and on-going pregnancy rates per embryo transfer were observed in D1-hCG (64%) compared to Control (41%). Conclusions Administration of D1-hCG prior to COH reduces rFSH use and enhances oocyte developmental competence to obtain top quality embryos, and improves implantation and on-going pregnancy rates. At present it is not clear if the benefit is related to producing an embryo that more likely to implant or a more receptive uterus, or merely fortuitous and related to the relatively small power of the study.

Androgens and poor responders: are we ready to take the plunge into clinical therapy?

“…Yet the positive effects of increasing androgen availability in the ovary, in particular, in women displaying a reduced number of growing follicles and/or follicle responsiveness to FSH still have to be clearly demonstrated in properly designed investigations. It is possible that the lukewarm results of studies aiming to examine the effects of exogenous (34)(35)(36)(37)(38)(39)(40) or endogenous (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48) androgens are, at least in part, due to methodological limitations, such as dose and duration of treatment. The ''androgen hypothesis'' remains interesting and plausible and should be examined in further prospective and randomized clinical trials.…”

“…Yet, this approach depends on the amount of androgens that effectively become available to ovarian follicles. The other approach that can be used to increase intraovarian androgen availability is to stimulate thecal production by administering LH activity (LH or hCG) (41)(42)(43). A third possibility to increase intraovarian androgens is the use of aromatase inhibitors (44)(45)(46)(47) to prevent androgen metabolism into estrogens.…”

“…Further studies are, therefore, required to examine the possible effects of longer and/ or more powerful pretreatments using higher doses of LH or hCG, a hormone whose biopotency is higher than that of LH. Indeed, in pilot studies, some investigators have obtained encouraging results with the use of hCG instead of LH before COH (42,43).…”

The tumor suppressor p53 induces expression of the pregnancy-supporting human chorionic gonadotropin (hCG)CGB7gene

“…[11][12][13] It was shown that implantation and pregnancy rates after IVF increase following treatment with hCG preparations underlining the important role of this hormonal stimulus. 14 hCG is active as a highly glycosylated heterodimer with the α-subunit common to luteinizing hormone (LH), folliclestimulating hormone (FSH) and thyrotropin (TSH), the distinct β-subunits of which confer the respective biological specificities. 15 The common α-subunit of this glycoprotein hormone family (GPHα, CGA) is expressed in both the placenta and the pituitary gland.…”

O papel da emergência de ondas foliculares na sincronização da estimulação ovariana para fertilização in vitro

“…(51)(52)(53)(54) . Como os níveis séricos desta gonadotrofina permaneceram detectáveis até o nono dia da estimulação e porque houve um aumento progressivo na quantidade de folículos médios ao longo do tratamento, possivelmente a partir do sétimo dia de estímulo, o hCG passou a promover o crescimento folicular em sincronia com o FSHr.…”