Comparison of efficacy of two different doses of recombinant human chorionic gonadotropin in in-vitro fertilization cycles to improve final oocyte quality: a prospective study

Abstract

The primary objective of our study is to assess the effect on the number of oocytes retrieved per follicle and number of mature metaphase II oocytes after triggering final follicular maturation using either 250 μg or 500 μg of r-hCG (Ovitrelle®, Serono, Spain) in IVF-ET cycles. The secondary objective was to compare clinical pregnancy rates and occurrence of ovarian hyperstimulation syndrome between the two groups. This was a prospective, randomized, single-centre, open-label study performed between June 2017 to August 2017 at the in-vitro fertilization unit in a tertiary care centre in North India. Seventy-six normal and poor-responder women planned for IVF-ET were included and underwent treatment with standard long GnRH agonist, antagonist or microdose-flare regimen according to baseline ovarian reserve. When two or more follicles had attained a maximum mean diameter of 18mm, follicular maturation was achieved by subcutaneous administration of either 250mcg (group 1-38 women) or 500mcg (group 2-38 women) of r-hCG (Ovitrelle®, Serono, Spain). Baseline demographic parameters were similar between the groups, however, basal serum anti-Mullerian hormone (AMH) level (5.32±2.20ng/dl versus 3.19±1.85ng/dl, respectively, P=0.008) and basal antral follicle count (AFC) were found to be significantly higher in group 1 compared to group 2 (17.03±7.23 versus 12.20±4.07, respectively, P=0.02). Mean number of oocytes retrieved per follicles were 67.40±23.95 and 77.57±23.36 in 250 μg r-hCG and 500 μg r-hCG groups, respectively, which was significantly higher with 500 μg r-hCG than the lower dose (P=.02). No significant differences were seen between the groups in terms of implantation rate and clinical pregnancy rates. Three women (8.5%) in group 1 and 2 women (5.7%) in group 2 had cycle cancellation due to failure of retrieval of oocytes, OHSS occurred in 2 patients, both of whom received 250mcg r-hCG. Due to heterogeneity between the groups with regard to ovarian reserve, we performed subgroup analysis in poor responder women, identified as subjects with antral follicle count (AFC) < 11 and AMH ≤ 1.1 ng/ml. In this population, the mean number of metaphase II oocytes per total oocytes was 33.71±26.45 in group 1 and 51.97±28.25 in group 2, and this was significantly higher in women who received 500mcg r-hCG (P=0.03). In our study, double dose of r-hCG when used to trigger final follicular maturation resulted in higher yield of oocytes per follicles and increased yield of metaphase II oocytes, especially in poor responders. However, further large randomized studies are needed to confirm our findings.