Abstract
Purpose: To illustrate whether low-dose human chorionic gonadotropin (hCG) administration during the early follicular phase could reduce the number of large preovulatory follicles in women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation using the progesterone protocol.Methods: We performed a randomized, controlled pilot trial at a university-affiliated tertiary hospital. A total of 40 infertile women undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment with the freeze-all strategy were included. Human menopausal gonadotropin (hMG) and progesterone soft capsule 100 mg/d were added simultaneously beginning from menstrual cycle day 3 for all participants. Low-dose hCG (200 IU) was injected every 3 days in the study group from the first day of ovarian stimulation until trigger. The primary outcome was the number of large preovulatory follicles. Secondary outcomes included the incidence of ovarian hyperstimulation syndrome (OHSS); the number of oocytes retrieved, mature oocytes, and good-quality embryos; and clinical results after frozen-thawed embryo transfer (FET) cycles.Results: The study group had slightly more large preovulatory follicles than the control group (17.75 ± 10 vs. 13.2 ± 5.34; P > 0.05). None of the participants experienced severe OHSS. There were no statistically significant differences in the number of oocytes retrieved (15.9 ± 8.46 vs. 15.75 ± 6.96), mature oocytes (13.55 ± 6.56 vs. 13.4 ± 6.34), and good-quality embryos (5.5 ± 3.41 vs. 4.9 ± 2.99) between the two groups (P > 0.05). Clinical pregnancy rates (65.52 vs. 41.94%; P = 0.067) and live birth rates (48.28 vs. 35.48%; P = 0.315) per transfer following FET of the study group were higher than those of the control group, but without statistical significance.Conclusions: Administration of low-dose hCG from the early follicular phase for PCOS patients undergoing ovarian stimulation with progesterone protocol may lead to slightly more early preovulatory follicles and marginally, but not significantly, higher clinical pregnancy rates. A continuous trial should be performed to explore the effects of supplementation with different doses of hCG from the start of ovarian stimulation in PCOS patients using the progesterone protocol.Clinical Trial Registration: Chictr.org.cn, identifier: ChiCTR-IOR-15007165
Highlights
The use of exogenous follicle-stimulating hormone (FSH) to promote multiple follicular development to yield multiple oocytes is well-established in assisted reproductive technology (ART), the addition of luteinizing hormone (LH) activity preparation remains controversial during ovarian stimulation
In prior decades of in vitro fertilization (IVF) treatments, it was considered that LH activity contained in human menopausal gonadotropin, which is mainly derived from human chorionic gonadotrophin, was detrimental to follicle growth and oocyte development during ovarian stimulation [1]
A total of 40 women were included, among which the first participant was recruited in November 2015, and the last participant was recruited in November 2017
Summary
The use of exogenous follicle-stimulating hormone (FSH) to promote multiple follicular development to yield multiple oocytes is well-established in assisted reproductive technology (ART), the addition of luteinizing hormone (LH) activity preparation remains controversial during ovarian stimulation. In prior decades of in vitro fertilization (IVF) treatments, it was considered that LH activity contained in human menopausal gonadotropin (hMG), which is mainly derived from human chorionic gonadotrophin (hCG), was detrimental to follicle growth and oocyte development during ovarian stimulation [1]. It was demonstrated that the number of small preovulatory ovarian follicles was inversely correlated with the hCG dose administered [4]
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