Investigation of luteal HCG supplementation in GnRH-agonist-triggered fresh embryo transfer cycles: a randomized controlled trial

Abstract

Research questionWill splitting the hCG support in GnRHa triggered IVF cycles result in a more optimal progesterone profile? DesignWe performed a randomized controlled 3-arm-study, at the Fertility Clinic, Odense University Hospital, Denmark.Patients with 12-25 follicles ≥ 12 mm, were randomized: Group 1: 6500 IU hCG for ovulation trigger. Group 2: 0.5 mg GnRHa for ovulation trigger followed by 1500 IU hCG on OPU. Group 3: 0.5 mg GnRHa for ovulation trigger, followed by 1000 IU hCG on OPU and 500 IU hCG on OPU+5 days. All groups received 180 mg vaginal progesterone. Eight blood samples were analyzed for progesterone. ResultsSixty-nine patients completed the study. Baseline and laboratory data were comparable. Progesterone peaked on OPU+4 in groups 1 and 2, compared to OPU+6 in group 3. On OPU+6, the progesterone in group 2 was significantly lower (p=0.03) compared to the other groups. On OPU+8, the progesterone in group 3 was significantly higher (p<0.001) compared to the other groups. Progesterone levels were significantly higher in group 3 from OPU+6 until OPU+14 compared individually to each of the other groups. Four patients developed OHSS in group 3. ConclusionSequential hCG support after a GnRHa trigger provides a more optimal progesterone levels in the luteal phase.