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Published in: Archives of Gynecology and Obstetrics 6/2011

01-12-2011 | General Gynecology

The effect of low dose human chorionic gonadotropin on follicular response and oocyte maturation in PCOS patients undergoing IVF cycles: a randomized clinical trial of efficacy and safety

Authors: Mahnaz Ashrafi, Kiandokht Kiani, Afsaneh Ghasemi, Fatemeh Rastegar, Maryam Nabavi

Published in: Archives of Gynecology and Obstetrics | Issue 6/2011

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Abstract

Purpose

To compare the efficacy of two regimens of low dose human chorionic gonadotropin (hCG) on follicular response and oocyte maturation in women with polycystic ovarian syndrome (PCOS).

Methods

Ninety women with PCOS who underwent assisted reproduction were eligible for this controlled, prospective, randomized study. Our trial was performed at Royan Institute Reproductive Research Center over a 24-month period. Ovarian stimulation in all groups was initiated with recombinant FSH, 150 IU daily. The dose and duration of FSH treatment were adjusted by monitoring follicular development with ultrasound and estradiol levels. Patients were randomized using a block randomization technique which assigned them to three groups: group A (control group) continued r-FSH until oocyte retrieval. In group B, r-FSH was reduced to 75 IU once the lead follicle reached 14 mm in mean diameter and low dose hCG (100 IU/day) was initiated. In group C, r-FSH was discontinued and low dose hCG (200 IU/day) was begun when the lead follicle reached 14 mm in mean diameter. The main outcome measure was follicular response and oocyte maturation.

Results

As compared to the FSH only group, groups which were given low dose hCG had lower gonadotropin consumption and fewer immature oocytes than the control group. No women in the low dose hCG groups developed severe ovarian hyper-stimulation syndrome. Fertilization, implantation and pregnancy rates were similar in the three groups.

Conclusions

A combination of FSH and low dose hCG improved oocyte maturity and preserved outcomes with improved safety and lowered cost.
Literature
1.
go back to reference Van Der Meer M, Hompes PG, De Boer JA, Schats R, Schoemaker J (1998) Cohort size rather than follicle-stimulating hormone threshold level determines ovarian sensitivity in polycystic ovary syndrome. J Clin Endocrinol Metab 83:423–426CrossRef Van Der Meer M, Hompes PG, De Boer JA, Schats R, Schoemaker J (1998) Cohort size rather than follicle-stimulating hormone threshold level determines ovarian sensitivity in polycystic ovary syndrome. J Clin Endocrinol Metab 83:423–426CrossRef
2.
go back to reference Filicori M, Cognigni GE, Tabarelli C, Pocognoli P, Taraborrelli S, Spettoli D, Ciampaglia W (2002) Stimulation and growth of antral ovarian follicles by selective LH activity administration in women. J Clin Endocrinol Metab 87:1156–1161PubMedCrossRef Filicori M, Cognigni GE, Tabarelli C, Pocognoli P, Taraborrelli S, Spettoli D, Ciampaglia W (2002) Stimulation and growth of antral ovarian follicles by selective LH activity administration in women. J Clin Endocrinol Metab 87:1156–1161PubMedCrossRef
3.
go back to reference Filicori M, Cognigni GE, Taraborrelli S, Parmegiani L, Bernardi S, Ciampaglia W (2002) Intracytoplasmic sperm injection pregnancy after low-dose human chorionic gonadotropin alone to support ovarian folliculogenesis. Fertil Steril 78:414–416PubMedCrossRef Filicori M, Cognigni GE, Taraborrelli S, Parmegiani L, Bernardi S, Ciampaglia W (2002) Intracytoplasmic sperm injection pregnancy after low-dose human chorionic gonadotropin alone to support ovarian folliculogenesis. Fertil Steril 78:414–416PubMedCrossRef
4.
go back to reference Filicori M, Cognigni GE, Gamberini E, Parmegiani L, Troilo E, Roset B (2005) Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation. Fertil Steril 84:394–401PubMedCrossRef Filicori M, Cognigni GE, Gamberini E, Parmegiani L, Troilo E, Roset B (2005) Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation. Fertil Steril 84:394–401PubMedCrossRef
5.
go back to reference Lee KL, Couchman GM, Walmer DK (2005) Successful pregnancies in patients with estrogenic anovulation after low-dose human chorionic gonadotropin therapy alone following hMG for controlled ovarian hyperstimulation. J Assist Reprod Genet 22:37–40PubMedCrossRef Lee KL, Couchman GM, Walmer DK (2005) Successful pregnancies in patients with estrogenic anovulation after low-dose human chorionic gonadotropin therapy alone following hMG for controlled ovarian hyperstimulation. J Assist Reprod Genet 22:37–40PubMedCrossRef
6.
go back to reference Sullivan MW, Stewart-Akers A, Krasnow JS, Berga SL, Zeleznik AJ (1999) Ovarian responses in women to recombinant follicle-stimulating hormone and luteinizing hormone (LH): a role for LH in the final stages of follicular maturation. J Clin Endocrinol Metab 84:228–232PubMedCrossRef Sullivan MW, Stewart-Akers A, Krasnow JS, Berga SL, Zeleznik AJ (1999) Ovarian responses in women to recombinant follicle-stimulating hormone and luteinizing hormone (LH): a role for LH in the final stages of follicular maturation. J Clin Endocrinol Metab 84:228–232PubMedCrossRef
7.
go back to reference Zeleznik AJ, Hillier SG (1984) The role of gonadotropins in the selection of the preovulatory follicle. Clin Obstet Gynecol 27:927–940PubMedCrossRef Zeleznik AJ, Hillier SG (1984) The role of gonadotropins in the selection of the preovulatory follicle. Clin Obstet Gynecol 27:927–940PubMedCrossRef
8.
go back to reference Thompson KA, LaPolt PS, River J, Henderson G, Dahl KD, Meldrum DR (1995) Gonadotropin requirements of the developing follicle. Fertil Steril 63:273–276PubMed Thompson KA, LaPolt PS, River J, Henderson G, Dahl KD, Meldrum DR (1995) Gonadotropin requirements of the developing follicle. Fertil Steril 63:273–276PubMed
10.
go back to reference The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25 The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25
11.
go back to reference World Health Organization (2001) Laboratory manual of the WHO for the examination of human semen and sperm-cervical mucus interaction. Ann Ist Super Sanita 37:I–XII, 1–123 World Health Organization (2001) Laboratory manual of the WHO for the examination of human semen and sperm-cervical mucus interaction. Ann Ist Super Sanita 37:I–XII, 1–123
12.
go back to reference Madani T, Ashrafi M, Abadi AB, Kiani K (2009) Appropriate timing of uterine cavity length measurement positively affects assisted reproduction cycle outcome. Reprod Biomed Online 19:734–736PubMedCrossRef Madani T, Ashrafi M, Abadi AB, Kiani K (2009) Appropriate timing of uterine cavity length measurement positively affects assisted reproduction cycle outcome. Reprod Biomed Online 19:734–736PubMedCrossRef
13.
go back to reference Baczkowski T, Kurzawa R, Glabowski W (2004) Methods of embryo scoring in in vitro fertilization. Reprod Biol 4:5–22PubMed Baczkowski T, Kurzawa R, Glabowski W (2004) Methods of embryo scoring in in vitro fertilization. Reprod Biol 4:5–22PubMed
14.
go back to reference Veeck LL (1992) Oocyte quality and assisted conception. Acta Eur Fertil 23:275–288PubMed Veeck LL (1992) Oocyte quality and assisted conception. Acta Eur Fertil 23:275–288PubMed
15.
go back to reference Aboulghar MA, Mansour RT (2003) Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update 9:275–289PubMedCrossRef Aboulghar MA, Mansour RT (2003) Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update 9:275–289PubMedCrossRef
16.
go back to reference Filicori M (1999) The role of luteinizing hormone in folliculogenesis and ovulation induction. Fertil Steril 71:405–414PubMedCrossRef Filicori M (1999) The role of luteinizing hormone in folliculogenesis and ovulation induction. Fertil Steril 71:405–414PubMedCrossRef
17.
go back to reference The European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone (2002) Efficacy and safety of highly purified menotropin versus recombinant follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection cycles: a randomized, comparative trial. Fertil Steril 78:520–528 The European and Israeli Study Group on Highly Purified Menotropin versus Recombinant Follicle-Stimulating Hormone (2002) Efficacy and safety of highly purified menotropin versus recombinant follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection cycles: a randomized, comparative trial. Fertil Steril 78:520–528
18.
go back to reference Agrawal R, Holmes J, Jacobs HS (2000) Follicle-stimulating hormone or human menopausal gonadotropin for ovarian stimulation in in vitro fertilization cycles: a meta-analysis. Fertil Steril 73:338–343PubMedCrossRef Agrawal R, Holmes J, Jacobs HS (2000) Follicle-stimulating hormone or human menopausal gonadotropin for ovarian stimulation in in vitro fertilization cycles: a meta-analysis. Fertil Steril 73:338–343PubMedCrossRef
19.
go back to reference Kilani Z, Dakkak A, Ghunaim S, Cognigni GE, Tabarelli C, Parmegiani L, Filicori M (2003) A prospective, randomized, controlled trial comparing highly purified hMG with recombinant FSH in women undergoing ICSI: ovarian response and clinical outcomes. Hum Reprod 18:1194–1199PubMedCrossRef Kilani Z, Dakkak A, Ghunaim S, Cognigni GE, Tabarelli C, Parmegiani L, Filicori M (2003) A prospective, randomized, controlled trial comparing highly purified hMG with recombinant FSH in women undergoing ICSI: ovarian response and clinical outcomes. Hum Reprod 18:1194–1199PubMedCrossRef
20.
go back to reference Ng EH, Lau EY, Yeung WS, Ho PC (2001) HMG is as good as recombinant human FSH in terms of oocyte and embryo quality: a prospective randomized trial. Hum Reprod 16:319–325PubMedCrossRef Ng EH, Lau EY, Yeung WS, Ho PC (2001) HMG is as good as recombinant human FSH in terms of oocyte and embryo quality: a prospective randomized trial. Hum Reprod 16:319–325PubMedCrossRef
21.
go back to reference Zeleznik AJ (2001) Follicle selection in primates: “many are called but few are chosen”. Biol Reprod 65:655–659PubMedCrossRef Zeleznik AJ (2001) Follicle selection in primates: “many are called but few are chosen”. Biol Reprod 65:655–659PubMedCrossRef
22.
go back to reference Yoshimura Y, Wallach EE (1987) Studies of the mechanism(s) of mammalian ovulation. Fertil Steril 47:22–34PubMed Yoshimura Y, Wallach EE (1987) Studies of the mechanism(s) of mammalian ovulation. Fertil Steril 47:22–34PubMed
23.
go back to reference Kyono K, Fuchinou K, Nakaj Y, Yag A, Sasaki K (2004) A prospective randomized study of three ovulation induction protocols for IVF: GnRH agonist versus antagonist with and without low dose hCG. Fertil Steril 82:S31CrossRef Kyono K, Fuchinou K, Nakaj Y, Yag A, Sasaki K (2004) A prospective randomized study of three ovulation induction protocols for IVF: GnRH agonist versus antagonist with and without low dose hCG. Fertil Steril 82:S31CrossRef
24.
go back to reference Serafini P, Yadid I, Motta EL, Alegretti JR, Fioravanti J, Coslovsky M (2006) Ovarian stimulation with daily late follicular phase administration of low-dose human chorionic gonadotropin for in vitro fertilization: a prospective, randomized trial. Fertil Steril 86:830–838PubMedCrossRef Serafini P, Yadid I, Motta EL, Alegretti JR, Fioravanti J, Coslovsky M (2006) Ovarian stimulation with daily late follicular phase administration of low-dose human chorionic gonadotropin for in vitro fertilization: a prospective, randomized trial. Fertil Steril 86:830–838PubMedCrossRef
25.
go back to reference Commenges-Ducos M, Piault S, Papaxanthos A, Ribes C, Dallay D, Commenges D (2002) Recombinant follicle-stimulating hormone versus human menopausal gonadotropin in the late follicular phase during ovarian hyperstimulation for in vitro fertilization. Fertil Steril 78:1049–1054PubMedCrossRef Commenges-Ducos M, Piault S, Papaxanthos A, Ribes C, Dallay D, Commenges D (2002) Recombinant follicle-stimulating hormone versus human menopausal gonadotropin in the late follicular phase during ovarian hyperstimulation for in vitro fertilization. Fertil Steril 78:1049–1054PubMedCrossRef
26.
go back to reference Gordon UD, Harrison RF, Fawzy M, Hennelly B, Gordon AC (2001) A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril 75:324–331PubMedCrossRef Gordon UD, Harrison RF, Fawzy M, Hennelly B, Gordon AC (2001) A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril 75:324–331PubMedCrossRef
28.
go back to reference Nargund G, Hutchison L, Scaramuzzi R, Campbell S (2007) Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles. Reprod Biomed Online 14:682–685PubMedCrossRef Nargund G, Hutchison L, Scaramuzzi R, Campbell S (2007) Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles. Reprod Biomed Online 14:682–685PubMedCrossRef
29.
go back to reference Gomez R, Lima I, Simon C, Pellicer A (2004) Administration of low-dose LH induces ovulation and prevents vascular hyperpermeability and vascular endothelial growth factor expression in superovulated rats. Reproduction 127:483–489. doi:10.1530/rep.1.00129 PubMedCrossRef Gomez R, Lima I, Simon C, Pellicer A (2004) Administration of low-dose LH induces ovulation and prevents vascular hyperpermeability and vascular endothelial growth factor expression in superovulated rats. Reproduction 127:483–489. doi:10.​1530/​rep.​1.​00129 PubMedCrossRef
30.
go back to reference Stokman PG, de Leeuw R, van den Wijngaard HA, Kloosterboer HJ, Vemer HM, Sanders AL (1993) Human chorionic gonadotropin in commercial human menopausal gonadotropin preparations. Fertil Steril 60:175–178PubMed Stokman PG, de Leeuw R, van den Wijngaard HA, Kloosterboer HJ, Vemer HM, Sanders AL (1993) Human chorionic gonadotropin in commercial human menopausal gonadotropin preparations. Fertil Steril 60:175–178PubMed
31.
go back to reference Filicori M, Cognigni GE, Pocognoli P, Tabarelli C, Spettoli D, Taraborrelli S, Ciampaglia W (2002) Modulation of folliculogenesis and steroidogenesis in women by graded menotropin administration. Hum Reprod 17:2009–2015PubMedCrossRef Filicori M, Cognigni GE, Pocognoli P, Tabarelli C, Spettoli D, Taraborrelli S, Ciampaglia W (2002) Modulation of folliculogenesis and steroidogenesis in women by graded menotropin administration. Hum Reprod 17:2009–2015PubMedCrossRef
Metadata
Title
The effect of low dose human chorionic gonadotropin on follicular response and oocyte maturation in PCOS patients undergoing IVF cycles: a randomized clinical trial of efficacy and safety
Authors
Mahnaz Ashrafi
Kiandokht Kiani
Afsaneh Ghasemi
Fatemeh Rastegar
Maryam Nabavi
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 6/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-010-1827-0

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