O-023 A randomized control trial on the effect of intrauterine HCG flushing on reproductive outcomes

Abstract

Abstract Study question Can Intra Uterine Flushing with Human Chorionic Gonadotropin (hCG) optimize embryo implantation and reproductive outcomes in Assisted Reproductive Technique(ART) cycles? Summary answer Uterine flushing with hCG does not seem to enhance embryo implantation and optimize reproductive outcomes What is known already Human Chorionic Gonadotropin (hCG) hormone has shown to play an important role in embryo implantation. Role of hCG flushing to uterine cavity has been proposed as one of the interventions to optimize embryo implantation, but its efficiency has been debatable. Study design, size, duration This study is a Randomised Control trial (RCT) with prior approval from Institution Ethical Review Board(IEC Ref. No. ECR/1312/inst/tg/2019). Study duration between November 2020-November 2021 at a private clinic. Women undergoing In-Vitro fertilization (IVF) cycles were randomised to no hCG flush group (n = 80) and hCG flush group (n = 100). Women >37yrs age and BMI >30 or having some uterine pathology or willing for Pre-Implantation Genetic Testing (PGT) or donor gamete cycles were excluded from this study Participants/materials, setting, methods Women recruited in this study underwent ovarian stimulation as per the institutes standard operating protocols (SOP). All embryos subjected to blastocyst culture and freeze all strategy followed. In a frozen embryo replacement cycle two good grade blastocysts were transferred. In hCG flush group, 48-72hrs before anticipated embryos transfer (ET) 500IU of commercially available hCG hormone was instilled into the uterine cavity. No hCG Flush group did not have any intervention Main results and the role of chance Clinical Pregnancy rates (CPR), Implantation Rates (IR), Multiple Pregnancy rates (MPR) were compared between the groups. Means of Reproductive outcomes between hCG Vs no hCG group were as follows CPR – 71% Vs 76% (p = 0.45) IR – 59% Vs 55%(p=0.59)MPR – 18% Vs 25%(p=0.25) Data from this RCT shows that hCG flush does not seem to enhance embryo implantation. Role of hCG flush to optimize reproductive outcomes is questionable. Limitations, reasons for caution This study has not evaluated the miscarriage rates and live birth rates Wider implications of the findings Ways to enhance embryo implantation and optimising reproductive outcomes still needs further research. hCG flushing might not be a beneficial intervention to optimise embryo implantation. However, a subgroup analysis to identify efficiency of hCG in a particular group of patients like thin endometrium could be further explored. Trial registration number NA