Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction

Abstract

The pregnancy outcome for cleavage-stage ETs using an IC-hCG dose of 500 IU or greater is promising. However, given the small size and the variable quality of the trials and the fact that the positive finding was from a subgroup analysis, the current evidence for IC-hCG treatment does not support its use in assisted reproduction cycles. A definitive large clinical trial with live birth as the primary outcome is recommended. There was no evidence that miscarriage was influenced by intrauterine hCG administration, irrespective of embryo stage at transfer or dose of IC-hCG. There were too few events to allow any conclusions to be drawn with regard to other complications.

Effect of intrauterine injection of human chorionic gonadotropin before fresh embryo transfer on IVF and ICSI outcomes: a meta-analysis

“…The dosages and types of hCG varied among the six RCTs. A meta-analysis published in 2016 found that a hCG dose of 500 IU or greater showed promise as the dosage before cleavage-stage ETs, but a hCG dose less than 500 IU before cleavage-stage ETs had no effect, and a dose of 500 IU or greater before blastocyst-stage ETs also showed no benefit [ 30 ]. Mansour’s study [ 3 ] reported that a 100- or 200 IU-hCG injection did not increase the pregnancy rate.…”

A Proteome Approach Reveals Differences between Fertile Women and Patients with Repeated Implantation Failure on Endometrial Level—Does hCG Render the Endometrium of RIF Patients?

“…The inconclusiveness is attributed to the heterogeneity of the trials (dosage, timing, origin of hCG source (urinary vs. recombinant) and developmental stage of embryos transferred). A sub-group investigation of the current Cochrane database analysis supports a benefit of a minimum of 500 IU hCG infused before cleavage stage embryos are transferred [13]. However, all babies born in our clinical setting resulted from blastocyst transfers and infusion of 500 IU hCG 10–15 min before transfer.…”

“…Another procedure focuses on influencing the endometrial receptivity. In this regard, methods like the endometrial injury in the cycle before the controlled ovarian stimulation to provoke an influx of immune competent cells [12] or the use of human chorionic gonadotropin (hCG) infusion prior to an embryo transfer are incorporated in therapy protocols but are discussed in contradictory terms in the literature [13,14]. HCG is produced by the syncytiotrophoblast and maintains the blood supply for the developing placenta.…”

“…Moreover, the hyperglycosylated form is synthesized by the cytotrophoblast and plays a role as an autocrine factor regulating implantation, invasion and cellular growth [15]. Furthermore, hCG modulates the endometrial receptivity and the maternal immune system in vitro [13,14,15,16]. Therefore, we hypothesized that the endometrium of patients suffering from RIF might benefit from the infusion of hCG prior to ET.…”

The Role of HCG in Implantation: A Mini-Review of Molecular and Clinical Evidence

“…Such sources of possible bias have been addressed by a recent Cochrane review [45]. The authors considered an overall meta-analysis on live birth and clinical pregnancy rates to be rather impossible due to high heterogeneity.…”