Human chorionic gonadotropin (hCG) plasma levels at oocyte retrieval and IVF outcomes

Abstract

Purpose The aim of our study was to ascertain the influence of hCG levels at oocyte pick-up on IVF outcomes, and their relationship with clinical parameters. Methods A prospective study was performed including 473 women undergoing IVF, aged under 40 years. Blood samples to analyze hCG levels were obtained at the time of follicular aspiration, 36 h after the administration of 250 μg of recombinant hCG.Results Neither the numbers of oocytes obtained or fertilized, nor the pregnancy rate, were correlated with hCG levels. Moreover, hCG values were very similar in women who did and did not become pregnant (123.3±48.7 and 117.5±44.7 mUI/mL). Cases in which no oocytes were recovered after follicular aspiration had similar hCG levels to those in which more than 1 oocyte was obtained. On the other hand, hCG levels were negatively related to body mass index, weight, and age. Conclusions These data indicate that after the administration of 250 μg of recombinant hCG, hCG levels are not responsible for failure to recover oocytes. Specifically, there was no correlation between plasma hCG levels and the number of oocytes obtained or other markers of IVF outcome. There was, however, an inverse relationship with BMI, body weight and age.

Failure of intrauterine insemination as rescue treatment in low responders with adequate HCG timing with no oocytes retrieved

“…Cases in which failure to obtain oocytes is not related to HCG problems include a variety of conditions, such as abnormal follicular development, impaired oocyte quality, oocyte retrival problems, previous ovulation, chance and the controversial genuine 'empty follicle' syndrome (Matorras et al, 2012a;Stevenson and Lashen, 2008;Zreik et al, 2000). Impaired oocyte quality is expected to occur more frequently in women with a low response.…”

“…During that period, a total of 6520 IVF cycles with own oocytes were started, all in women younger than 40 years of age, as this is a mandatory criterion in all Spanish public hospitals (Matorras et al, 2012a). Exclusion criteria for IVF were the same as the general criteria for patients in our public centre: age 40 years or older; three or more previous IVF failures; two previous cycles with poor response (less than four oocytes obtained in spite of an adequate stimulation protocol); poor ovarian reserve (FSH greater than 13 mUI/ml between 2000 and 2008, anti-Müllerian hormone less than 0.4 ng/mL and antral follicle count less than 6 between 2008 and 2012); infection risk; prenatal genetic diagnosis; or contraindication for pregnancy (Matorras et al, 2003(Matorras et al, , 2012a.…”

“…Women reaching follicular aspiration not obtaining oocytes were offered rescue IUI if all the following inclusion criteria were meet: follicular ultrasound showing one to six follicles greater than 13 mm (mean diameter) on the day of HCG administration (all the cases showing only one to two follicles greater than 13 mm had previously refused to follow our standard policy of switching to an IUI instead of performing ooctye retrieval; HCG levels immediately after failure to obtain oocytes over 23 UI/ml, based on our previous research (Matorras et al, 2012a); at least one patent tube; and a motile sperm count after preparation over 3 million/mL, as in our general IUI programme. A total of 54 rescue IUIs were carried out.…”

“…A number of conditions may be responsible for this failure: premature ovulation; deficient or insufficient administration of human chorionic gonadotrophin (HCG); 'empty follicle' syndrome; technical problems in oocyte retrieval (Matorras et al, 2012a); impaired folliculogenesis (Ben-Shlomo et al, 1991); and, infrequently, genetic conditions (Yariz et al, 2011). Most cases of failure to obtain oocytes are related to problems with HCG dose or timing (Stevenson and Lashen, 2008).…”

Basal follicle stimulating hormone and leptin on the day of hCG administration predict successful fertilization in <em>in vitro</em> fertilization

“…4 In IVF cycles, hCG administration is used as a surrogate luteinizing hormone (LH) surge to induce development and maturation of larger ovarian follicles (≥15 mm in diameter) that have acquired granulose cell LH/hCG receptors. 5,6 For this reason, leptin serum level is needed to be examined around the time when predicted oocyte maturation occurs, which is in the day of hCG administration for oocyte maturation. In addition, since maturation of each oocyte was being assessed, leptin level in each follicle was obtained by measuring the ratio of leptin serum level with oocyte count.…”