Abstract
PurposeThis analysis was performed to evaluate the effects of intrauterine injection of human chorionic gonadotropin (hCG) before fresh embryo transfer (ET) on the outcomes of in vitro fertilization and intracytoplasmic sperm injection.MethodsRandomized controlled trials (RCTs) were identified by searching electronic databases. The outcomes of live birth, clinical pregnancy, implantation, biochemical pregnancy, ongoing pregnancy, ectopic pregnancy, and miscarriage between groups with and without hCG injections were analyzed. Summary measures were reported as risk ratios (RR) with 95% confidence intervals.ResultsSix RCTs on fresh embryo transfer (ET) were included in the meta-analysis. A total of 2759 women undergoing fresh ET were enrolled (hCG group n = 1429; control group n = 1330). Intrauterine injection of hCG significantly increased rates of biochemical pregnancy (RR 1.61) and ongoing pregnancy (RR 1.58) compared to controls. However, there were no significant differences in clinical pregnancy (RR 1.11), implantation (RR 1.17), miscarriage (RR 0.91), ectopic (RR 1.65) or live birth rates (RR 1.13) between the hCG group and control group.ConclusionThe current evidence for intrauterine injection of hCG before fresh ET does not support its use in an assisted reproduction cycle.
Highlights
One in six-to-seven couples suffer from infertility worldwide [1]
Comprehensive literature searches were conducted on PubMed, Web of Science, SCOPUS, and EBSCO from the date of inception to August 2017 without restriction to regions, publication types, or languages, using the search strategy [Title/Abstract]: (“human chorionic gonadotropin” or “hCG” or “rhCG” or “recombinant hCG”) AND (“intrauterine administration” or “intrauterine injection” or “intrauterine administration” or “endometrial infusion”) AND (“assisted reproductive techniques” or “ART” or “in vitro fertilization” or “IVF” or “ICSI” or “intracytoplasmic sperm injections” or “embryo transfer” or “implantation”)
We did not construct funnel plots to examine publication bias, or perform meta-regression analyses or subgroup analyses because of the small number of Randomized controlled trials (RCTs) included in this meta-analysis. This meta-analysis with 2759 patients from 6 RCTs examined the effect of intrauterine injection of hCG before fresh embryo transfer (ET) on pregnancy outcomes, and showed that this intervention did not improve the live birth rate for the fresh ET cycle
Summary
One in six-to-seven couples suffer from infertility worldwide [1]. Despite advances in assisted reproductive techniques (ARTs), the pregnancy rate remains unsatisfactory [2–4]. Implantation, a critical stage of pregnancy, is a complex process, such that more than half of all pregnancy failures are caused by implantation failure [5]. Three components are considered to be essential for successful implantation, process-embryo quality, endometrial receptivity, and embryo–endometrium communication [6]. Embryo–endometrium communication is regulated by autocrine and paracrine factors of which human chorionic gonadotropin (hCG) is considered the most important [7]. Embryos begin to transcript hCG at the two-cell stage and secrete hCG before implantation [5]. The endometrial epithelial cells produce hCG, which acts in an autocrine–juxtacrine manner, until its appearance in the serum [8]. HCG regulates implantation by different mechanisms, for example, it facilitates trophoblast
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