Abstract
Human chorionic gonadotropin (hCG) is no longer a single, omnipotent ovulation triggering option. Gonadotropin releasing hormone (GnRH) agonist, initially presented as a substitute for hCG, has led to a new era of administering GnRH agonist followed by hCG triggering. According to this new concept, GnRH agonist enables successful ovum maturation, while hCG supports the luteal phase and pregnancy until placental shift.
Highlights
The physiological luteinizing hormone (LH) surge, well-known as the crucial step in ovum meiosis and maturation, as well as in maturation of its supporting cells, has been traditionally replaced by human chorionic gonadotropin in artificial reproductive technologies (ART) cycles
When urinary human chorionic gonadotropin (hCG) was compared to the recombinant form, no statistically significant differences were detected in terms of pregnancy rate, live birth rate, ovarian hyper-stimulation syndrome (OHSS) and miscarriage rate
Others have described follicle stimulating hormone (FSH) receptor mutations as a mechanism that explains some of the cases presenting with OHSS [22,23]. It seems that the general background conditions for OHSS should include multiple corpora lutea, which respond to hCG and lead to very large increases in VEGF production and VEGF receptivity. If such distinctive intracellular events follow LH/hCG receptor (LHCGR) activation by hCG compared to LH, and if hCG is closely related to the occurrence of OHSS, why is recombinant LH not commonly used for final ovarian maturation? In a multicenter study, patients received either rhLH or u-hCG to achieve final follicular maturation [9]
Summary
The physiological luteinizing hormone (LH) surge, well-known as the crucial step in ovum meiosis and maturation, as well as in maturation of its supporting cells, has been traditionally replaced by human chorionic gonadotropin (hCG) in artificial reproductive technologies (ART) cycles. When urinary hCG was compared to the recombinant form, no statistically significant differences were detected in terms of pregnancy rate, live birth rate, ovarian hyper-stimulation syndrome (OHSS) and miscarriage rate. The most troubling issue arising from the use of hCG for final follicular maturation is ovarian hyperstimulation syndrome (OHSS), because of its prolonged clearance.
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