Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical pregnancy rates from in vitro fertilisation cycles: a prospective study

Olga Pashkova,Julio F De la Jara,Jorge García,Ana P Sánchez,Álvaro Santibañez,Omar Colín,Guillermo Castellanos

doi:10.1186/1477-7827-12-9

Abstract

BackgroundThe implantation process after embryo transfer depends on the embryo quality and endometrial receptivity. It is estimated that fifty to seventy-five per cent of pregnancies are lost due to a failure of implantation. There is evidence that there is an early secretion of human chorionic gonadotrophin before embryo implantation, and this secretion has been linked to an important function in angiogenesis and the inflammatory response that promotes the implantation process. Our objective was to determine the effects of intrauterine injection of human chorionic gonadotropin (hCG) before the embryo transfer in an in vitro fertilisation cycle.MethodsA prospective randomised study was conducted in Reproductive Medicine Centre PROCREA in Mexico City. Infertile patients who had a medical indication for in vitro fertilisation were studied. Two groups were included (n 210); the intervention group received an intrauterine injection of 500 IU of hCG before the embryo transfer (n 101). The control group (n 109) did not receive hCG. Comparisons were performed using a chi-square test.ResultsThe clinical pregnancy rate (CPR) was our principal outcome. The implantation rate was a secondary outcome. The implantation rate was significantly higher in the hCG group compared to the control group (52.4% vs 35.7%, p 0.014). The clinical pregnancy rate was also significantly higher (50.4 vs 33.0%, p 0.010). No adverse effects were observed.ConclusionsThe intrauterine injection of hCG before embryo transfer showed a significant increase in the clinical pregnancy rate. More clinical trials are needed to reproduce these results on this promising intervention. The live birth rate must be included in subsequent studies.

Highlights

The implantation process after embryo transfer depends on the embryo quality and endometrial receptivity
Berndt et al reported that human chorionic gonadotropin (hCG) displayed a potent angiogenic effect through receptor activation of transforming growth factor beta (TGF-β) in endothelial cells, which is a key role in placental development [10]
A total of 210 infertile women under the age of 40 who had an indication for an In Vitro Fertilisation (IVF)/Intracytoplasmic sperm injection (ICSI) cycle were enrolled in the study

Summary

Introduction

The implantation process after embryo transfer depends on the embryo quality and endometrial receptivity. The hCG can modulate the receptivity of the endometrial stromal cells to interleukin-1 by upregulating its receptor (IL1R) during the implantation window This function has an impact on angiogenesis, which is a pathway by which embryonic growth is promoted [9]. After the administration of 500 UI of hCG, they found a significant inhibition of intrauterine insulin-like growth factor binding protein 1 (IGFBP-1) and the macrophage colony-stimulating factor (M-CSF), while leukemia inhibitory factor (LIF), the vascular endothelial growth factor (VEGF) and the matrix metallopeptidase 9 (MMP-9) were significantly stimulated These multiple effects appear to precede the classical endocrine role of the hCG and could be directly involved in the regulation of embryo implantation [12]

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