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Svenstrup L, Möller S, Fedder J, Pedersen D, Erb K, Andersen C, Humaidan P. Does the hCG trigger dose used for final oocyte maturation in IVF impact luteal phase progesterone levels? - A randomized controlled trial. Reprod Biomed Online 2022; 45:793-804. [DOI: 10.1016/j.rbmo.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/12/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
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Luo Y, Sun L, Dong M, Zhang X, Huang L, Zhu X, Nong Y, Liu F. The best execution of the DuoStim strategy (double stimulation in the follicular and luteal phase of the same ovarian cycle) in patients who are poor ovarian responders. Reprod Biol Endocrinol 2020; 18:102. [PMID: 33059712 PMCID: PMC7566062 DOI: 10.1186/s12958-020-00655-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/24/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients found to be poor ovarian responders (POR) are a challenging patient population for any assisted reproduction technology. Despite attempts at various controlled ovarian stimulation schemes, reproductive outcomes in this patient population have not improved. In recent years, the DuoStim protocol (both follicular and luteal phase stimulation during the same menstrual cycle) has shown a potential for use in patients with POR. METHODS This retrospective study reviewed the medical records of 304 women who were diagnosed as POR and underwent the DuoStim protocol. We compared follicular phase stimulation (FPS) data and luteal phase stimulation (LPS) data of the same patients. We also compared the effects of different trigger drugs including urine human chorionic gonadotropin (uHCG; 10,000 IU), recombinant human chorionic gonadotropin (rHCG; 250 μg), and gonadotropin-releasing hormone agonist (GnRH-a; 0.2 mg) at the FPS and LPS stages. RESULTS POR undergoing the DuoStim protocol resulted in a significantly higher number of oocytes retrieved, normal fertilised oocytes, cleaved embryos, cryopreserved embryos, and good quality embryos at the LPS stage than at the FPS stage. Trigger drugs at the FPS stage did not affect the FPS stage data. Regardless of the stage, rHCG and GnRH-a yielded significantly more cryopreserved embryos and good quality embryos than uHCG. CONCLUSION The use of GnRH-a or rHCG as the trigger drug may be better than uHCG in both the FPS and LPS stages for POR undergoing the DuoStim protocol. This will increase the number of good quality embryos at the LPS stage. We found that the LPS stage results in more oocytes (and therefore more embryos) than the FPS stage.
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Affiliation(s)
- Yanqun Luo
- grid.412601.00000 0004 1760 3828The First Affiliated Hospital of Jinan University, 613 Huangpu Avenue West, Tianhe District, Guangzhou, 510630 Guangdong Province China
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Li Sun
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Mei Dong
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Xiqian Zhang
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Li Huang
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Xiulan Zhu
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Yingqi Nong
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
| | - Fenghua Liu
- grid.459579.3Department of Reproductive Medical Center, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511400 Guangdong Province China
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Wang J, Yang T, Mei H, Yu X, Peng H, Wang R, Cai Y. Comparative Pharmacokinetics, Bioequivalence and Safety Study of Two Recombinant Human Chorionic Gonadotropin Injections in Healthy Chinese Subjects. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:435-444. [PMID: 32099328 PMCID: PMC6996485 DOI: 10.2147/dddt.s235064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/31/2019] [Indexed: 01/10/2023]
Abstract
Objective To evaluate the pharmacokinetics (PK), bioequivalence and safety profile of the recombinant human chorionic gonadotropin (r-hCG) injection formulation LZM003 (test drug) comparing with that of Ovidrel® (reference drug) in healthy Chinese subjects. Methods This is a randomized, single-blind, single-dose, two-arm and two-period crossover Phase I study. Subjects were randomized evenly to a single dose of LZM003 or reference drug injected subcutaneously, with a 10-day or longer between-treatment washout period. PK parameters, anti-drug antibodies (ADAs), and adverse events (AEs) were assessed. The primary PK endpoints were area under the curve (AUC) of the concentration-time curve from zero to last quantifiable concentration (AUC0-t), AUC from zero to infinity (AUC0-∞), and peak concentration (Cmax). Bioequivalence was determined by assessing whether the 90% confidence intervals (CIs) for the geometric mean ratio (GMR) of LZM003 to reference drug fell within predefined margins of 80% -125%. Results Forty-eight subjects (24 males and 24 females) were enrolled and one subject withdrew for personal reasons. Mean values of primary PK parameters were similar (p > 0.05) between LZM003 and the reference drug. The 90% CIs for primary PK endpoints' GMR of LZM003 to reference drug ranged between 0.9144 and 1.1845, which were within bioequivalence margins of 80-125%. Incidence of AEs was similar (p > 0.05) between the two groups. Neither LZM003 nor reference drug produced anti-drug antibody (ADA) in healthy subjects. Conclusion LZM003 and reference drug were bioequivalent. The PK and safety assessments were similar (p > 0.05) between the two formulations in healthy Chinese subjects. Trial Registration Number ChiCTR-IIR-16010158 (http://www.chictr.org.cn). Trial Registration Date December 15, 2016.
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Affiliation(s)
- Jin Wang
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, People's Republic of China
| | - Tianli Yang
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, People's Republic of China
| | - Hekun Mei
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, People's Republic of China
| | - Xueming Yu
- Livzon MabPharm Inc, Zhuhai, Guangdong 519045, People's Republic of China
| | - Hongmei Peng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, People's Republic of China
| | - Rui Wang
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, People's Republic of China
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, People's Republic of China
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Singh N, Girish B, Malhotra N, Mahey R, Perumal V. Does Double Dose of Recombinant Human Chorionic Gonadotropin for Final Follicular Maturation in In vitro Fertilization Cycles Improve Oocyte Quality: A Prospective Randomized Study. J Hum Reprod Sci 2019; 12:310-315. [PMID: 32038081 PMCID: PMC6937770 DOI: 10.4103/jhrs.jhrs_125_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/05/2019] [Accepted: 11/01/2019] [Indexed: 11/04/2022] Open
Abstract
Context In in vitro fertilization (IVF) cycles, the recommended dose of recombinant human chorionic gonadotropin (r-hCG), for triggering final follicular maturation is 250 μg, although there is some disagreement. Aims The aim of our study was to assess the effect on the number of mature oocytes retrieved after triggering ovulation in IVF cycles using 250 μg or 500 μg of r-hCG. Settings and Design Prospective, single-center, randomized study. Subjects and Methods 100 women undergoing IVF with embryo transfer. The primary outcome measure was the total number of oocytes retrieved per follicle, number of mature oocytes, and number of embryos generated. The secondary outcomes included clinical and biochemical pregnancy rates and incidence of ovarian hyperstimulation syndrome. Results Mean number of oocytes retrieved (6.5 ± 4.0 vs. 6.4 ± 3.9, P = 0.3) and mean number of mature oocytes (4.0 ± 2.3 vs. 3.2 ± 2.3, P = 0.09) were similar in the two groups; however, mean number of oocytes retrieved per follicle was found to be higher with 500 μg r-hCG (67.4 ± 23.9 vs. 77.5 ± 23.3, P = 0.04). In the subgroup of poor responder women, there was a significant increase in the number of mature oocytes retrieved with double dose of r-hCG (2.2 ± 1.8 vs. 3.7 ± 1.9, P = 0.06), leading to improvement in fertilization and clinical pregnancy rates. Conclusions Double dose of r-hCG for final follicular maturation in IVF cycles resulted in improvement in mean number of oocytes per follicle but did not result in improved pregnancy rates in the women. In the subset of poor responders, 500 μg r-hCG seems to be more advantageous than the lower dose, although larger randomized trials are needed to generalize this strategy.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Girish
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Zhang YL, Wang FZ, Huang K, Hu LL, Bu ZQ, Sun J, Su YC, Guo YH. Factors predicting clinical pregnancy rate of in vitro fertilization-embryo transfer (a STROBE-compliant article). Medicine (Baltimore) 2019; 98:e18246. [PMID: 31852091 PMCID: PMC6922498 DOI: 10.1097/md.0000000000018246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the factors predicting clinical pregnancy rate of in vitro fertilization-embryo transfer (IVF-ET).The data of 9960 patients receiving IVF-ET fresh cycle at our Reproductive Center from January 2009 to December 2017 were first divided into pregnant group and non-pregnant group to find the clinical pregnancy rate-related factors. According to the serum HCG levels at 36 hours and 12 hours after HCG trigger, all patients were divided into 4 groups including <50 mIU/ml, ≥50 and <100 mIU/ml, ≥100 and <200 mIU/ml, and ≥200 mIU/ml groups to know whether the HCG levels at 36 hours and 12 hours affect the pregnancy rate. According to the serum HCG ratio at 36 hours to 12 hours (36 h/12 h) after HCG trigger, all patients were divided into three groups including <0.88, 0.88-1.06 and >1.06 groups to observe whether the serum HCG ratio (36 h/12 h) affects the clinical pregnancy rate. According to different assisted pregnancy modes, all patients were divided into 3 groups including IVF, ICSI, and IVF/ICSI groups to observe whether the assisted pregnancy mode affects the clinical pregnancy rate. The correlation of the clinical pregnancy rate with pregnancy rate-related factors obtained above was analyzed using logistic regression analysis model.The clinical pregnancy rate significantly increased (P < .01) in the HCG ratio (36 h/12 h) >1.06 group as compared with the HCG ratio (36 h/12 h) < 0.88 and 0.88-1.06 groups. The serum estrogen (E2) level at 36 hours was significantly lower and the number of retrieved oocytes was significantly higher in the HCG ratio (36 h/12 h) >1.06 group than in the HCG ratio (36 h/12 h) <0.88 and 0.88-1.06 groups (P = .000).The serum HCG ratio (36 h/12 h) may be used as a predictor of IVF-ET clinical pregnancy rate. High clinical pregnancy rate is probably associated with E2 down-regulation in the HCG ratio (36 h/12 h) >1.06 group.
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Affiliation(s)
- Yi-Le Zhang
- Reproductive Medical Center of the First Hospital of Zhengzhou University, Zhengzhou, China
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Human chorionic gonadotropin serum levels following ovulation triggering and IVF cycle outcome. J Assist Reprod Genet 2018; 35:891-897. [PMID: 29572693 DOI: 10.1007/s10815-018-1165-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome. METHODS A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10-12 h following ovulation triggering with 250 mcg r-hCG. Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after controlling for confounders. RESULTS Overall, 326 cycles were included. Median serum hCG level was 91.35 IU/L. hCG levels were lower as age and BMI were higher (p = 0.004, p < 0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p = 0.14), live birth rate (p = 0.09), fertilization rate (p = 0.45), or metaphase II oocyte rate (p = 0.68). On multivariate regression analysis, hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98-1.005), after controlling for patient's age and BMI. CONCLUSIONS hCG levels on the day after ovulation triggering with 250 mcg r-hCG are inversely correlated with patient age and BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after ovulation induction seems futile and cannot be recommended.
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Cha YJ, Kim KA, Oh TY, Park JY. Pharmacokinetics and Safety Profile of DA-3803, a Proposed Biosimilar of Recombinant Human Chorionic Gonadotropin, in Healthy Subjects. BioDrugs 2015; 29:199-205. [PMID: 25998212 DOI: 10.1007/s40259-015-0128-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE DA-3803 is a proposed biosimilar of recombinant human chorionic gonadotropin (r-hCG), which is a therapeutic protein used to treat infertility. We compared the pharmacokinetics and safety profiles of DA-3803 (test) with those of a conventional formulation (Ovidrel(®), reference). METHODS A single-blind, randomized, single-dose, two-period, two-sequence, crossover study was conducted in 32 healthy subjects. In each period, 250 μg of r-hCG of the test or reference formulation was administered subcutaneously with a 3-week washout period. Serial blood samples were obtained for pharmacokinetic analysis and blood levels of human chorionic gonadotropin (hCG) were determined. The geometric mean ratios (GMRs) with 90 % confidence intervals (CIs) for the maximum (peak) plasma concentration (C max) and the area under the plasma concentration-time curve (AUC) were estimated. RESULTS Among the 32 subjects, 27 completed the study. No serious adverse events were observed. The mean concentration-time profiles of the test formulation tended to be higher than those of the reference formulation. The mean C max values of the two products were similar (142 mIU/mL for reference vs. 143 mIU/mL for test), but the mean AUC from time zero to infinity (AUC∞) values of the test drug were approximately 25 % higher than those of the reference drug (9403 mIU·h/mL for reference vs. 11,817 mIU·h/mL for test). The GMR (90 % CI) of the test formulation to the reference formulation for C max, AUC from time zero to the last measurable time (AUClast), and AUC∞ were 1.03 (0.93-1.14), 1.25 (1.18-1.33), and 1.27 (1.19-1.35), respectively. CONCLUSION A single subcutaneous injection of either DA-3803 or Ovidrel(®) was safe and well-tolerated. A comparative pharmacokinetics study showed that DA-3803 was bioequivalent to Ovidrel(®) in the C max value but non-equivalent in the AUC value. These pharmacokinetic differences may not be expected to affect therapeutic efficacy of these two drugs, but further clinical studies are warranted to confirm their therapeutic equivalence.
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Affiliation(s)
- Yu-Jung Cha
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, 126-1, 5-Ga, Anam-dong, Sungbuk-Gu, Seoul, 136-705, Korea
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Madani T, Mohammadi Yeganeh L, Ezabadi Z, Hasani F, Chehrazi M. Comparing the efficacy of urinary and recombinant hCG on oocyte/follicle ratio to trigger ovulation in women undergoing intracytoplasmic sperm injection cycles: a randomized controlled trial. J Assist Reprod Genet 2012; 30:239-45. [PMID: 23274511 DOI: 10.1007/s10815-012-9919-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 12/13/2012] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the number of oocytes per follicles in ovulation induction with 10,000 IU urinary hCG (uhCG) and two different doses of recombinant hCG (rhCG) in women undergoing intracytoplasmic sperm injection (ICSI) cycles. METHODS This study was a prospective, randomized controlled trial which was performed on 180 primary infertile women undergoing ICSI cycles. All eligible patients underwent a standard GnRH-a long protocol. When at least two follicles reached a diameter of 18 mm, all patients were randomized to receive 10,000 IU urinary hCG or 250 μg recombinant hCG or 500 μg recombinant hCG for ovulation induction. Primary outcome measure included the number of oocytes retrieved per aspirated follicles. Secondary outcome measures were the number of oocytes retrieved, the number of mature oocytes, the number and quality of generated embryos, fertilization rate, implantation rate, chemical and clinical pregnancy rates and OHSS occurrence rate. RESULTS The mean number of retrieved oocytes per follicles were 71.82 ± 15.09, 69.84 ± 17.44 and 77.16 ± 17.61 in 10,000 IU uhCG, 250 μg rhCG and 500 μg rhCG, respectively which was significantly higher with 500 μg rhCG than the lower dose(P = .04). Other cycles and clinical outcomes were comparable between groups. CONCLUSION Recombinant hCG shows equivalent efficacy to urinary hCG in terms of the number of oocytes per aspirated follicles in selected patients undergoing ICSI; however, 500 μg rhCG seems to be more advantageous than the lower dose in this indication. Larger randomized trials are needed to generalize this strategy.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, No 12 East Hafez Avenue, Tehran, Iran
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Clua E, Martínez F, Tur R, Sanmartín P, Chueca A, Barri PN. Triggering ovulation with 250 μg or 500 μg of r-hCG in oocyte donors treated with antagonist protocol has no effect on the number of mature oocytes retrieved: a randomized clinical trial. Gynecol Endocrinol 2012; 28:678-81. [PMID: 22304627 DOI: 10.3109/09513590.2011.652244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to compare two r-hCG doses to trigger ovulation (250 μg vs. 500 μg of r-hCG) in an oocyte donation program. A prospective, randomized study was conducted in 118 oocyte donors. Group DI received 250 μg and Group DII received 500 μg of r-hCG. Both the groups were homogeneous. No significant differences were found in the total dose of gonadotropins, duration of the treatment, total number of oocytes, or Metaphase II (MII)oocytes. The pregnancy rate per embryo transfer in the corresponding recipients was similar for both the groups (58.2% for DII recipients and 56.1% for DI recipients). Mild hyperstimulation was observed in 17 donors in Group DI (29%) and in 23 donors in Group DII (39%). No cases of severe ovarian hyperstimulation syndrome (SOHSS) were observed. In conclusion, a double dose of r-hCG in oocyte donors to trigger ovulation after stimulation with r-FSH and antagonist does not translate into a higher number of MII oocytes retrieved or into higher pregnancy rates among recipients. Our results confirm that the optimal dose to induce the final oocyte maturation with r-hCG is 250 μg, and that a higher dose does not add any benefit.
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Affiliation(s)
- Elisabet Clua
- Servei de Medicina de la Reproducció, Departament d'Obstetrícia, Ginecologia i Reproducció, Institut Universitari Dexeus, Barcelona, Spain.
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Matorras R, Meabe A, Mendoza R, Prieto B, Ramón O, Mugica J, Aspichueta F, Exposito A. Human chorionic gonadotropin (hCG) plasma levels at oocyte retrieval and IVF outcomes. J Assist Reprod Genet 2012; 29:1067-71. [PMID: 22815004 DOI: 10.1007/s10815-012-9826-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022] Open
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.
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Affiliation(s)
- R Matorras
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Cruces University Hospital, C/Plaza de Cruces S/N. 48903 Baracaldo, Vizcaya, Spain.
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Maman E, Yung Y, Kedem A, Yerushalmi GM, Konopnicki S, Cohen B, Dor J, Hourvitz A. High expression of luteinizing hormone receptors messenger RNA by human cumulus granulosa cells is in correlation with decreased fertilization. Fertil Steril 2012; 97:592-8. [PMID: 22260850 DOI: 10.1016/j.fertnstert.2011.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 12/17/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To elucidate the LH receptor (LHR) expression patterns in human granulosa cells (GCs) from antral to preovulatory stages, and to investigate a correlation to oocyte function. DESIGN Luteinized preovulatory GCs were obtained from preovulatory follicles aspirated during IVF (≥ 17 mm). The GCs from small- (<10 mm) and medium-sized (10-15 mm) follicles were obtained during in vitro maturation (IVM) procedures. Cumulus GCs were obtained during oocyte denudation for intracytoplasmatic sperm injection (ICSI) procedures (IVF). SETTING Referral center. PATIENT(S) Seventy IVF patients and 20 IVM patients. INTERVENTION(S) GC collection. MAIN OUTCOME MEASURE(S) The LHR expression levels in mural and cumulus GCs of different follicular sizes and their correlation to oocyte outcome. RESULT(S) The LHR expression increased with follicle size and was higher in mural GCs compared with cumulus cells. The LHR expression in cumulus GCs from preovulatory follicles was higher in metaphase II (MII) oocytes than in metaphase I or germinal vesicle oocytes (IVF). Unexpectedly, higher expression of LHR in cumulus GCs of MII oocytes correlated with decreased fertilization rates. CONCLUSION(S) The LHR expression in small follicles obtained in IVM suggests a role for hCG administration during IVM procedures. Overexpression of LHR in cumulus GCs of MII oocytes may signal malfunction of oocytes and low fertilization capacity.
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Affiliation(s)
- Ettie Maman
- IVF Unit and Fertility Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel
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A prospective, randomized, controlled study to compare two doses of recombinant human chorionic gonadotropin in serum and follicular fluid in woman with high body mass index. Fertil Steril 2010; 93:2084-7. [DOI: 10.1016/j.fertnstert.2009.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 07/20/2009] [Accepted: 08/07/2009] [Indexed: 11/24/2022]
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Tsoumpou I, Muglu J, Gelbaya TA, Nardo LG. Optimal dose of HCG for final oocyte maturation in IVF cycles: absence of evidence? Reprod Biomed Online 2009; 19:52-8. [DOI: 10.1016/s1472-6483(10)60045-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lorusso F, Palmisano M, Serratì G, Bassi E, Lamanna G, Vacca M, Depalo R. Intrauterine insemination with recombinant or urinary human chorionic gonadotropin: A prospective randomized trial. Gynecol Endocrinol 2008; 24:644-8. [PMID: 19031222 DOI: 10.1080/09513590802308107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM Our aim was to compare the efficacy and safety of recombinant and urinary human chorionic gonadotropin (rhCG and uhCG, respectively) for the induction of follicle maturation in women undergoing intrauterine insemination (IUI). METHODS Patients were randomized to receive rhCG or uhCG. IUI was carried out 24 h (day 1) and 48 h (day 2) after hCG administration, except for all cases in which ovulation occurred after 24 h. RESULTS The two treatments were comparable in terms of progesterone levels on day 7 and day 12. Pregnancy rates were comparable between the treatment groups. Of the 64 women who received rhCG, 29.7% became pregnant; there were 16.7% clinical pregnancies and 3.1% biochemical pregnancies per started cycle, and an ongoing pregnancy rate of 93.7% was reported. Of the 61 patients who received uhCG, 24.6% became pregnant; there were 15.9% clinical pregnancies and 1.1% biochemical pregnancies per started cycle, and ongoing pregnancy rate was 92.9%. No adverse effects were noted in either group. CONCLUSION The recombinant products can be effectively used instead of urinary products; moreover, apart from the equivalent efficacy in ovulation induction and safety described in this study, it is necessary to consider the advantages provided by the recombinant form.
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Affiliation(s)
- Filomenamila Lorusso
- Department of Gynaecology, Obstetrics and Neonatology, Gynaecology and Obstetric Unit A, University of Bari, Bari, Italy.
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Kolibianakis EM, Papanikolaou EG, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Triggering final oocyte maturation using different doses of human chorionic gonadotropin: a randomized pilot study in patients with polycystic ovary syndrome treated with gonadotropin-releasing hormone antagonists and recombinant follicle-stimulating hormone. Fertil Steril 2007; 88:1382-8. [PMID: 17445806 DOI: 10.1016/j.fertnstert.2006.12.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Revised: 12/17/2006] [Accepted: 12/17/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of different human chorionic gonadotropin (hCG) doses on the ongoing pregnancy rates in patients with polycystic ovary syndrome (PCOS). DESIGN Prospective, randomized, controlled trial. SETTING Tertiary university referral center. PATIENT(S) Eighty PCOS patients. INTERVENTION(S) Patients were randomized to receive 10,000 IU (n = 28), 5000 IU (n = 26), or 2500 IU (n = 26) of hCG for triggering final oocyte maturation as soon as >or=3 or more follicles of 17 mm or larger were present at ultrasound. Patients were stimulated with recombinant follicle stimulating hormone (FSH) and daily gonadotropin-releasing hormone (GnRH) antagonist, starting on day 6 of stimulation. MAIN OUTCOME MEASURE(S) Ongoing pregnancy, fertilization rates. RESULT(S) The median fertilization rates were 52.8%, 65.4%, and 55.6% after administration of 10,000 IU, 5000 IU and 2500 IU, respectively. The ongoing pregnancy rates per PCOS patient receiving hCG were 26.9% (7 of 26), 30.8% (8 of 26) and 34.8% (8 of 23), respectively. CONCLUSION(S) A decrease in the dose of hCG used to trigger final oocyte maturation does not appear to affect adversely the probability of pregnancy in PCOS patients treated by IVF using GnRH antagonists and recombinant FSH, and further testing in future larger-scale trials is recommended.
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Chan CCW, Ng EHY, Tang OS, Ho PC. Endometrial, subendometrial, and ovarian stromal blood flow in patients treated with two different doses of recombinant human chorionic gonadotropin. Fertil Steril 2006; 85:520-2. [PMID: 16595247 DOI: 10.1016/j.fertnstert.2005.07.1313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Revised: 07/01/2005] [Accepted: 07/01/2005] [Indexed: 11/23/2022]
Abstract
The effects of two different doses of recombinant hCG on blood flow to the uterus and ovary on the day of oocyte retrieval were studied by three-dimensional Doppler ultrasonography in 60 women during IVF treatment. There were no differences in all the indices of endometrial, subendometrial, and ovarian stromal blood flow in women who had received 250 microg or 500 microg of recombinant hCG for final oocyte maturation.
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Affiliation(s)
- Carina Chi-Wai Chan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, People's Republic of China.
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Macklon NS, Stouffer RL, Giudice LC, Fauser BCJM. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev 2006; 27:170-207. [PMID: 16434510 DOI: 10.1210/er.2005-0015] [Citation(s) in RCA: 327] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To allow selection of embryos for transfer after in vitro fertilization, ovarian stimulation is usually carried out with exogenous gonadotropins. To compensate for changes induced by stimulation, GnRH analog cotreatment, oral contraceptive pretreatment, late follicular phase human chorionic gonadotropin, and luteal phase progesterone supplementation are usually added. These approaches render ovarian stimulation complex and costly. The stimulation of multiple follicular development disrupts the physiology of follicular development, with consequences for the oocyte, embryo, and endometrium. In recent years, recombinant gonadotropin preparations have become available, and novel stimulation protocols with less detrimental effects have been developed. In this article, the scientific background to current approaches to ovarian stimulation for in vitro fertilization is reviewed. After a brief discussion of the relevant aspect of ovarian physiology, the development, application, and consequences of ovarian stimulation strategies are reviewed in detail.
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Affiliation(s)
- Nick S Macklon
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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Chan CCW, Ng EHY. Is 250 μg rHCG always better and safer than 500 μg rHCG? Hum Reprod 2006; 21:569-70. [PMID: 16423839 DOI: 10.1093/humrep/dei341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chan CCW, Liu VWS, Lau EYL, Yeung WSB, Ng EHY, Ho PC. Mitochondrial DNA content and 4977 bp deletion in unfertilized oocytes. ACTA ACUST UNITED AC 2006; 11:843-6. [PMID: 16421213 DOI: 10.1093/molehr/gah243] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies analysing the incidences of mitochondrial DNA (mtDNA) deletions and mtDNA content in unfertilized oocytes in relation to donors' age have been controversial. The objective of the study was to compare these two parameters in unfertilized oocytes and relate them to the donors' age. Fifty-two women donated 155 unfertilized metaphase II (MII) oocytes. The incidence of 4977 bp deletion was 34.6%, and the mtDNA copy number was 598 350 +/- 265 862. Women >or=35 years of age had a significantly higher incidence of 4977 bp deletion, lower mtDNA copy number, higher FSH level and poorer ovarian response when compared with younger women. The mtDNA copy number was negatively correlated with the donor's age. The higher incidence of mtDNA deletion and lower mtDNA copy number in older women suggested that these two parameters may reflect ovarian ageing.
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Affiliation(s)
- C C W Chan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
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Ng EHY, Chan CCW, Tang OS, Yeung WSB, Ho PC. Factors affecting endometrial and subendometrial blood flow measured by three-dimensional power Doppler ultrasound during IVF treatment. Hum Reprod 2005; 21:1062-9. [PMID: 16373406 DOI: 10.1093/humrep/dei442] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND No information exists in the literature regarding the factors affecting the blood flow towards the endometrial and subendometrial regions during IVF treatment. METHODS We examined the effect of women's age, their smoking habits, their type of infertility (i.e. primary or secondary) and parity, causes of infertility and serum estradiol (E2) concentration on endometrial and subendometrial blood flows as measured by a three-dimensional (3D) power Doppler ultrasound during IVF treatment. All patients received a standard long protocol of ovarian stimulation and serum E2 concentration was determined on the day of hCG. 3D ultrasound examination with power Doppler was performed on the day of oocyte collection to determine vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions. RESULTS The age of women, their smoking habits, their types of infertility and parity and causes of infertility had no effect on the endometrial and subendometrial 3D power Doppler flow indices. There was a negative correlation between serum E(2) concentration and endometrial FI (r = -0.109; P = 0.006). CONCLUSIONS Endometrial blood flow in IVF treatment was negatively affected by serum E2 concentration only.
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Affiliation(s)
- Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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