Randomized, Controlled Pilot Study of Low-Dose Human Chorionic Gonadotropin Administration Beginning From the Early Follicular Phase for Women With Polycystic Ovarian Syndrome Undergoing Ovarian Stimulation Using the Progesterone Protocol

Abstract

Purpose: To illustrate whether low-dose human chorionic gonadotropin (hCG) administration during the early follicular phase could reduce the number of large preovulatory follicles in women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation using the progesterone protocol. Methods: We performed a randomized, controlled pilot trial at a university-affiliated tertiary hospital. A total of 40 infertile women undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment with the freeze-all strategy were included. Human menopausal gonadotropin (hMG) and progesterone soft capsule 100 mg/d were added simultaneously beginning from menstrual cycle day 3 for all participants. Low-dose hCG (200 IU) was injected every 3 days in the study group from the first day of ovarian stimulation until trigger. The primary outcome was the number of large preovulatory follicles. Secondary outcomes included the incidence of ovarian hyperstimulation syndrome (OHSS); the number of oocytes retrieved, mature oocytes, and good-quality embryos; and clinical results after frozen-thawed embryo transfer (FET) cycles. Results: The study group had slightly more large preovulatory follicles than the control group (17.75 ± 10 vs. 13.2 ± 5.34; P > 0.05). None of the participants experienced severe OHSS. There were no statistically significant differences in the number of oocytes retrieved (15.9 ± 8.46 vs. 15.75 ± 6.96), mature oocytes (13.55 ± 6.56 vs. 13.4 ± 6.34), and good-quality embryos (5.5 ± 3.41 vs. 4.9 ± 2.99) between the two groups (P > 0.05). Clinical pregnancy rates (65.52 vs. 41.94%; P = 0.067) and live birth rates (48.28 vs. 35.48%; P = 0.315) per transfer following FET of the study group were higher than those of the control group, but without statistical significance. Zhu and Fu hCG Usage in Ovarian Stimulation of PCOS Conclusions: Administration of low-dose hCG from the early follicular phase for PCOS patients undergoing ovarian stimulation with progesterone protocol may lead to slightly more early preovulatory follicles and marginally, but not significantly, higher clinical pregnancy rates. A continuous trial should be performed to explore the effects of supplementation with different doses of hCG from the start of ovarian stimulation in PCOS patients using the progesterone protocol.

A Randomized Controlled Trial on the Efficacy and Safety of Low-Dose hCG in a Short Protocol with GnRH Agonist and Ovarian Stimulation with Recombinant FSH (rFSH) During the Follicular Phase in Infertile Women Undergoing ART

“…A different, compared to our study, practice of hCG administration has been investigated in a Cochrane review (33); authors aimed to assess the effectiveness and safety of low-dose hCG when replacing FSH for COH: that did not reduce the chance of ongoing and clinical pregnancy and resulted in an equivalent [42], there were no significant differences between pregnancy rates in the two study groups. In a recent RCT, the administration of low-dose hCG daily from the early follicular phase in PCOS patients through a progesterone protocol did not manage to improve the number of retrieved and mature oocytes and good-quality embryos, along with implantation and clinical pregnancy rates [43].…”

“…In a similar study carried out later [ 42 ], there were no significant differences between pregnancy rates in the two study groups. In a recent RCT, the administration of low-dose hCG daily from the early follicular phase in PCOS patients through a progesterone protocol did not manage to improve the number of retrieved and mature oocytes and good-quality embryos, along with implantation and clinical pregnancy rates [ 43 ].…”

Proteomic alteration of endometrial tissues during secretion in polycystic ovary syndrome may affect endometrial receptivity

“…Even though many researchers focus on the pathophysiology of PCOS, the etiology underlying PCOS is still unknown. Many present studies mainly focused on improving clinical symptoms, such as insulin resistance, obesity, metabolic derangements, and increase in androgen, to achieve successful conceiving, reduce pregnancy-related complications, and enhance pregnancy outcomes [ 2 , 3 ]. Ovulation disorders were previously considered the main cause of infertility in patients with PCOS.…”