Urinary Human Chorionic Gonadotropin (hCG), Intramuscular or Subcutaneously Administered, Yields higher hCG Serum and Follicular Levels Than Recombinant hCG in Egg Donors

Abstract

Benefits of easy and improved local tolerance of subcutaneous recombinant HCG (rhCG) administration has been widely reported. To evaluate and compare the efficacy and safety of 250 microg of recombinant hCG with 10,000 UI of urinary hCG (uhCG) in egg donors administered subcutaneously or intramuscularly. Prospective, randomized, double blind clinical trial. Sixty egg donors from November 2003 to June 2004 who underwent a controlled ovarian hyperstimulation (COH) in our clinic were included. Using a random number table, egg donors were randomized into one of three treatment arms. COH was followed by 10,000 IU uhCG injection, given intramuscularly (i.m.) (n=20) or subcutaneously (s.c.) (n=20), or 250 microg rhCG by s.c route (n=20). Only egg donors with body mass index below 32 and between 18 to 35 years old were accepted. There were no statistically significant differences in age or body mass index (BMI) among donors receiving uhCG or rhCG sc-im. Mean days of stimulation, total dose of gonadotrophins were similar in all groups. Mean number of oocytes retrieved per treatment group were similar as well as mean numbers of metaphase II oocytes retrieved. There were no differences between mean numbers of zygotes obtained in both groups. No patients with no oocytes retrieved were found. Implantation rate and pregnancy rate were similar in recipients. Serum oestradiol and progesterone levels were similar in all groups on day of oocyte retrieval and 5 days after hCG injection, as well as progesterone levels in follicular fluid. Statistically significant differences were found in hCG serum and follicular fluid levels between groups (* p < 0.01). No adverse events were registered by any patient receiving hCG by either injection method. Tabled 1 Recombinant and urinary hCG subcutaneously administered are effective and well tolerated in the induction of final follicular maturation and luteinization in egg donors. This investigation suggests that clinical use of uhCG by sc. is suitable for egg donors and could enhance the fulfilment. In addition, lower hCG serum and follicular levels were obtained with rhCG group and that could be considered in high responders with increased risk of ovarian hyperstimulation syndrome.