Day Of hCG Administration Research Articles

Is endometrial thickness on day of transfer a predictor of pregnancy rate in IVF?

Multiple factors can affect IVF success rate including endometrial receptivity, quality of the embryo and the transfer technique. Some studies have shown that endometrial thickness is a good indicator of endometrial receptivity. The majority of studies have examined the sonographic appearance of the endometrium on the day of hCG administration. The objective of this study was to test the hypothesis that endometrial thickness measured on the day of embryo transfer (EMT-ET) may be more informative of IVF success rates than EMT evaluated on the day of hCG administration (EMT-hCG).

Day 3 embryo metabolomics in the spent culture media is altered in obese women undergoing IVF

To determine whether the metabolomic profile in the spent culture media of day-3 embryos is different in obese and normoweight women undergoing IVF, also considering the association with polycystic ovary syndrome (PCOS). Prospective case-control analysis. Twenty-eight young (< 38 years) women with normal uterus and ovaries, and absence of endometriosis, hydrosalpinx or smoking habit were recruited. Patients underwent their first IVF attempt due to idiopathic infertility, tubal factor, or failed intrauterine insemination, presenting a normoweight male partner without severe sperm factor. Group A included ovulatory obese (body mass index >30 kg/m2) women (n =12); group B included obese women with PCOS (Rotterdam criteria) (n =4); group C (control) included normoweight (20-24.9 kg/m2) ovulatory oocyte donors (n =12). Exclusion criteria were: <5 or >20 oocytes retrieved; >3.000 pg/ml or >20% fall in estradiol concentration, or >1 ng/ml of progesterone concentration on the day of hCG administration; or <2 ongoing embryos in day 3. A GnRH antagonist protocol using rFSH and hCG triggering was employed. Culture spent media were taken (50 μl) from two embryos of each cohort (with similar morphology) in day 3, analyzing a total of 56 embryos. Samples were centrifuged, frozen (-80ºC) and stored until the analysis was performed comparing the global metabolomic profile of the three groups by ultrahigh performance liquid chromatography coupled to mass spectrometry. The untargeted metabolic profiling analysis of embryo-spent culture media from controls, obese-PCOS and obese-non-PCOS women revealed a different metabolomic profile. Principal component and Partial Least Squares Discriminant Analysis resulted in a clear separation of the three types of samples when a total of 600 metabolites were considered. A good model of prediction was obtained using the 160 most consistent metabolites. This model was able to predict the origin of the sample with 13% and 10% of false negatives and positives, respectively. The metabolic profile in the spent culture media of day-3 embryos is different in normoweight and obese women with a higher deviation when PCOS is associated.

High serum estradiol levels on the day of hCG administration during controlled ovarian hyperstimulation is associated with the increased risk of ectopic pregnancy in a dose-response manner

High serum estradiol levels on the day of hCG administration during controlled ovarian hyperstimulation is associated with the increased risk of ectopic pregnancy in a dose-response manner

Defining the “sweet spot” for administered luteinizing hormone-to-follicle-stimulating hormone gonadotropin ratios during ovarian stimulation to protect against a clinically significant late follicular increase in progesterone: an analysis of 10,280 first in vitro fertilization cycles

To determine whether different ratios of administered LH-to-FSH influence the risk of clinically relevant late follicular P elevations and whether there is an optimal range of LH-to-FSH to mitigate this risk. Retrospective cohort. Private academic center. A total of 10,280 patients undergoing their first IVF cycle. None. The ratio of exogenous LH-to-FSH throughout stimulation and association with absolute serum P level≥1.5 ng/mL on the day of hCG administration. Stimulations using no administered LH (N=718) had the highest risk of P elevation≥1.5 ng/mL (relative risk [RR]=2.0; 95% confidence interval [CI] 1.8-2.2). The lowest risk of P increase occurred with an LH-to-FSH ratio of 0.30:0.60 (20%; N=4,732). In contrast, ratios<0.30, reflecting proportionally less administered LH (N=4,847) were at increased risk for premature P elevation (32%, RR=1.6; 95% CI 1.5-1.7) as were ratios>0.60 (23%, RR 1.1; 95% CI 1.0-1.3). This pattern of lowest risk in the 0.30-0.60 range held true for cycles characterized by low, normal, and high response. When performing a logistic regression to control for multiple confounding variables this relationship persisted. Absent or inadequate LH dosing is associated with a risk for a late follicular elevation in P sufficient to induce suboptimal outcomes. A total LH-to-FSH ratio of 0.30:0.60 was associated with the lowest risk of P elevation. Optimization of this parameter should be considered when making gonadotropin dosing decisions.

Co-administration of GnRH-agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles--a preliminary report.

BackgroundRecently, the co-administration of GnRH agonist and hCG for final oocyte maturation- 40 and 34 hours prior to OPU, respectively (double trigger) was suggested as the treatment of genuine empty follicle syndrome. In the present study, we aim to evaluate whether the double trigger improves the number of oocytes retrieved in patients with low (<50%) number of oocytes retrieved per number of preovulatory follicles.MethodsIn this proof of concept cohort historical study, we compared the stimulation characteristics of 8 IVF cycles, which include the double trigger to the patients’ previous IVF attempt, triggered with hCG-only.ResultsPatients who received the double trigger (study group) had a significantly higher number of oocytes retrieved, number of 2PN, number of embryos transferred and significantly higher proportions of the number of oocytes retrieved to the number of follicles >10 mm and >14 mm in diameter on day of hCG administration, with a tendency toward a higher number of TQE, as compared to their previous cycles (hCG-only trigger). Three ongoing clinical pregnancies were recorded in the study group and none in the hCG-only trigger group.ConclusionsCo-administration of GnRH-agonist and hCG for final oocyte maturation, 40 and 34 hours prior to OPU, respectively (double trigger), is suggested as a valuable new tool in the armamentarium for treating patients with low/poor oocytes yield despite an apparently normal follicular development and E2 levels and in the presence of optimal hCG levels on the day of OPU.

Influence of follicle rupture and uterine contractions on intrauterine insemination outcome: a new predictive model

To correlate the detection of follicle rupture and the number of uterine contractions per minute with the outcome of IUI and to build a predictive model for the outcome of IUI including these parameters. Retrospective cohort study. Fertility clinic. We analyzed data from 610 women who underwent homologous or donor double IUI from 2005 to 2010 and whose data of uterine contractions or follicle rupture were recorded. None. Live-birth rate. Nine hundred seventy-nine IUI cycles were included. The detection of follicle rupture (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.30-3.01) and the number of uterine contractions per minute (OR, 1.67; 95% CI, 1.02-2.74) assessed after the second insemination procedure of a double IUI were positively correlated with the live-birth rate. A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were significantly associated with the live-birth rate. Follicle rupture and uterine contractions are associated with the success of an IUI cycle. This may open new possibilities to improve the methodology of IUI.

Live birth rates after IVF are reduced by both low and high progesterone levels on the day of human chorionic gonadotrophin administration.

Are low serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration detrimental for live birth delivery rates during in vitro fertilization (IVF)? Progesterone levels ≤0.5 ng/ml on the day of hCG administration hinder live birth rates. Fundamental research has shown that the presence of late follicular phase progesterone is essential for follicular development, ovulation and endometrial receptivity. However, previous studies in patients undergoing ovarian stimulation have only assessed if progesterone levels in the higher range are detrimental for pregnancy or not. That said, information on the effect of the full range of late follicular progesterone on IVF outcomes is still lacking. This was a retrospective, single-centre cohort study with 2723 cycles performed in patients aged between 19 and 36 and undergoing controlled ovarian stimulation between January 2006 and March 2012 for their first or second attempt of IVF followed by a fresh embryo transfer (ET). All patients underwent ovarian stimulation using a gonadotrophin-releasing hormone (GnRH) antagonist for pituitary down-regulation. Final oocyte maturation was triggered with hCG 36 h before oocyte retrieval. On the day of hCG administration, serum progesterone evaluation was performed. Live birth delivery rates were compared amongst various ordinal and regular progesterone intervals (≤0.50, 0.50-0.75, 0.75-1.00, 1.00-1.25, 1.25-1.50, >1.50 ng/ml) using logistic regression. The average age of our sample was 30.5 years. Almost 82% of all embryo transfers were of a single embryo and 51.8% were performed with a Day 5 embryo. The average value (±standard deviation) of progesterone on the day of hCG administration was 1.02 ± 0.50 ng/ml and the live birth rate was 23.4%. The live birth rates (according to the above-described ordinal serum progesterone intervals) were 17.1, 25.1, 26.7, 25.5, 21.9 and 16.6%, respectively. The live birth rates were significantly lower in patients with both low (≤0.5 ng/ml) and high (>1.5 ng/ml) late follicular progesterone levels (P < 0.05). The main limitation of our study was its retrospective nature. Furthermore, our study was restricted to patients under GnRH antagonist pituitary suppression and requires confirmation in a GnRH agonist setting. This study comprehensively assessed the relationship between live birth delivery rates and progesterone levels on the day of hCG administration during ovarian stimulation for IVF. Clinically relevant lower (≤0.5 ng/ml) and higher (>1.5 ng/ml) progesterone level limits were determined. No funding was received for this study and the authors have no conflicts of interest to declare.

Endometrial pattern, thickness and growth in predicting pregnancy outcome following 3319 IVF cycle

A retrospective study of 3319 women was conducted to assess predictive ability of endometrial characteristics for outcomes of IVF and embryo transfer. Endometrial thickness, growth and pattern were assessed at two time points (day 3 of gonadotrophin stimulation and day of HCG administration). Endometrial patterns were classified as pattern A: triple-line pattern comprising a central hyperechoic line surrounded by two hypoechoic layers; pattern B: an intermediate isoechogenic pattern with the same reflectivity as the surrounding myometrium and poorly defined central echogenic line; and pattern C: homogenous, hyperechogenic endometrium. The endometrium of pregnant women was thinner on day 3 of stimulation, thicker on the day of HCG administration, and showed greater growth in thickness compared with non-pregnant women. Clinical pregnancy rates differed according to endometrial pattern on the day of HCG administration (55.2%, 50.9% and 37.4% for patterns A, B and C, respectively). A positive linear relationship was found between endometrial thickness on the day of HCG administration and clinical pregnancy rate. Endometrial thickness, change and pattern were independent factors affecting outcome. Receiver operator characteristic curves showed that endometrial pattern, thickness and changes were not good predictors of clinical pregnancy. Discriminant analysis indicated that 58.7% of original grouped cases were correctly classified. Although endometrium with triple-line or increased thickness may favour pregnancy, combined endometrial characteristics do not predict outcomes.

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection

Background: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection.Materials and methods: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients.Results: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p > 0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7 ± 0.7 versus 2.6 ± 0.6).Conclusion: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients.

Effect of ultrasound endometrium pattern at the day of hCG administration on clinical outcome in patients undergoing in vitro fertilization and embryo transfer

Objective To investigate the prediction value of ultrasound endometrial pattern at the day of hCG administration on clinical outcome in patients undergoing in vitro fertilization-embryo transfer (IVF-ET).Methods 679 cycles of IVF-ET conducted between January 2011 and December 2012 in Beijing Obstetrics and Gynecology Hospital were reviewed retrospectively.All cycles were divided into three groups based on the endometrial pattern measured on the hCG day:group A (n =411) with triple line endometrium,group B (n =228) with no obvious triple line endometrium,group C (n =40) with homogeneous hyperechoic endometrium.Clinical outcomes such as implantation rate,pregnancy rate and miscarriage rate were analyzed.Results Among three groups,the implantation rates were 27.05％,20.33％,19.57％,respectively (x2 =9.04,P =0.01); the pregnancy rates were 34.31％,25.00％,12.50％,respectively (x2 =12.20,P =0.00).The implantation rate and pregnancy rate in group A were higher than the other two groups (P ＜0.05).The miscarriage rates were 16.31％,19.30％,40.00％,respectively(P ＞ 0.05),there were no significant difference among them.Conclusions The ultrasound endometrium pattern on the day of hCG administration has predictive value on clinical outcome in patients undergoing in vitro fertilization-embryo transfer. Key words: Endosonography; Endometrium; Fertilization in vitro; Embryo transfer; Implantation rates ; Pregnancy rate

Transient intrauterine fluid accumulation not due to hydrosalpinx or any identifiable pelvic pathology is not detrimental to IVF outcome.

This study is to assess whether transient intrauterine fluid accumulation (IUFA) first noted during controlled ovarian hyperstimulation that does not persist on the day of embryo transfer not due to any identifiable pelvic pathology has any detrimental effect on in vitro fertilization (IVF) outcome. From a database of 16,900 cycles, 144 patients with transient "physiological" IUFA were recruited. Four hundred fifty-one consecutive patients who had male factor infertility served as the control group. The amount of IUFA classified as largest dimension in the antero-posterior (AP) plane; ≤2, 3-5 or >5mm. The mean female age, the mean number of embryos transferred and endometrial thickness on the day of hCG administration were comparable among the study and control groups. Similarly, clinical pregnancy, ongoing pregnancy and implantation rates were comparable among the study and control groups. Female age was noted to be the only significant independent predictor of ongoing pregnancy. The AP dimension of IUFA did not have any impact on pregnancy and implantation rates. Transient IUFA not due to hydrosalpinx or any identifiable pelvic pathology has no detrimental effect on IVF pregnancy rates. Hence, cycle cancellation should be avoided in such cycles.

Timing of human chorionic gonadotropin (hCG) hormone administration in IVF/ICSI protocols using GnRH agonist or antagonists: a systematic review and meta-analysis

Objective: To evaluate the effect of altering the timing of human chorionic gonadotropin (hCG) administration on the clinical outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using gonadotropic hormone releasing hormone (GnRH) agonist or antagonist.Methods: We systematically searched six databases. Randomized controlled trials (RCTs) of the effects of altering the timing of hCG administration on the clinical outcome of IVF and ICSI using GnRH agonist or antagonist were included. A meta-analysis was conducted following a quality evaluation performed with Cochrane Collaboration’s Review Manager (RevMan) 5.0.2.Results: Seven RCTs and a total of 1295 participants were included. Significant difference was observed regarding estradiol and progesterone levels on the day of hCG administration and oocyte retrieval between early hCG and late hCG administration group and in favor of the latter. The fertilization rate was not statistically different between early and 24-h late hCG groups, but it is significantly higher in the 48-h late hCG group. The pooled results showed no significant differences in the ongoing pregnancy rate per oocyte pick-up, the miscarriage rate and the live birth rate.Conclusion: The prolongation of follicular phase by delaying hCG administration could increase estradiol, progesterone levels and oocyte retrieval, which will not influence ongoing pregnancy rate per oocyte pick-up, miscarriage rate and live birth rate. Postponing hCG may enable increased flexibility of cycle scheduling to avoid weekend procedures.

Mini-dose GnRH-a long versus short protocol in patients ≥35 years old undergoing in vitro fertilization

Purpose: To compare the clinical result of mini-dose GnRH-a long protocol with short protocol in older patients undergoing IVF.Materials and methods: This was a retrospective study. Four hundred and sixty-one women aged above 35-year-old in first cycle were assigned to two groups: GnRH-a short protocol (n = 359); and mini-dose GnRH-a long protocol (n = 102). Both groups were divided based on their age, into groups over and under 38 years old. Primary outcome include live birth rate per started cycle. Other clinical outcomes were good-quality embryo rate, clinical pregnancy rate.Results: Patients treated with mini-dose GnRH-a protocol and those treated with short protocol showed similar live birth rate. In the mini-dose long protocol group aged 35–38 years old, patients showed significantly thicker endometrium at the day of hCG administration, higher number of good embryos obtained and higher good-quality embryo rate (56.3% versus 46.5%) compared with short protocol. The implantation rate and clinical pregnancy rate were higher versus short protocol group, but this result was not statistically significant.Conclusion(s): Mini-dose GnRH-a long protocol for older women is at least as effective as short protocol, especially in patients aged 35–38 years, with a better good-quality embryo rate and higher number of good embryos obtained, therefore mini-dose GnRH-a long protocol can be considered as an alternative protocol for patients above 35 years age.

Serum estradiol level change after human chorionic gonadotropin administration had no correlation with live birth rate in IVF cycles

ObjectiveTo investigate the correlation between the estradiol (E2) level change after hCG administration and the live birth rate in GnRH agonist long or short protocols, and to explore the possible factors related to E2 dynamics after hCG administration during controlled ovarian hyperstimulation (COH). Study designA retrospective analysis was performed on 2868 patients who received IVF/intracytoplasmic sperm injection (ICSI) treatment with GnRH agonist long or short protocol. The patients were divided into three groups according to their serum E2 changes after hCG administration, and the live birth rates were compared among groups. The area under the receiver operating characteristic (ROC) curve was calculated to assess the predictive value of E2 change for the probability of live birth. Logistic regression analysis was also applied to exclude interference from various confounding factors. Finally, multivariate regression analysis was conducted to assess factors related to the E2 change after hCG administration. ResultsNo significant difference was observed in live birth rates (4.26%, 36.38% or 30.81% in long protocol (P=0.697); 25.81%, 26.71% or 30.81% in short protocol (P=0.697)) among patients with increasing, plateauing or decreasing E2 responses after hCG administration. The area under the ROC curve for the E2 change in prediction of live birth rate was 0.506 in long protocol, or 0.524 in short protocol. Logistic regression analysis showed that the serum E2 change after hCG administration had no correlation with live birth rate. Multivariate regression analysis showed that the percentage of mature follicles (larger than 14mm) and the duration of stimulation negatively correlated with the E2 change after hCG administration. ConclusionsIn GnRH agonist cycles, the serum E2 change after hCG administration had no correlation with live birth rate in fresh embryo transfer cycles, and this change negatively correlated with the percentage of mature follicles on the day of hCG administration.

The comparision of effect of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients

Purpose: To compare the effects of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.Methods: Of 225 patients, 83 patients were in microdose flare-up group (Group 1), 70 patients were in GnRH antagonist/letrozole group (Group 2) and 72 patients were in GnRH antagonist/clomiphene citrate group (Group 3). Demographic and endocrine characteristics, the total number of oocytes retrieved, cancellation rate and clinical pregnancy rate were collectedResults: Total dosage of gonadotropins (p = 0.002) and serum E2 levels on the day of hCG administration (p = 0.010) were significantly higher and duration of stimulations (p = 0.03) was significantly longer in group 1. The number of oocytes retrieved was significantly greater in group 1 and 2 when compare to those of group 3 (p = 0,000). There was a trend towards increasing cycle cancellation rates with GnRH antagonist/clomiphene citrate and GnRH antagonist/letrozole.Conclusion: Our finding suggest that the results of microdose flare-up protocol are better than other two used treatment protocols, in terms of maximum estradiol levels, number of mature oocytes retrieved, and cancellation rate and it still seems to be superior the ovarian stimulation regime for the poor responder patients.

High Maternal Serum Estradiol Environment in the First Trimester Is Associated With the Increased Risk of Small-for-Gestational-Age Birth

There are increasing concerns that a disrupted endocrine environment may disturb the growth of the fetus. Assisted reproductive technology (ART) situates gamete/embryo in a supraphysiological estradiol (E2) environment and, thus, provides an ideal model to investigate this problem. Our objective was to investigate whether the maternal high-E2 environment in the first trimester increases the risks of low birth weight (LBW) and small-for-gestational-age (SGA) birth. In total, 8869 singletons born after fresh embryo transfer (ET) (n = 2610), frozen ET (n = 1039), and natural conception (NC) (n = 5220) and their mothers were included. Birth weight, LBW, SGA, and maternal serum E2 levels were investigated. The mean serum E2 levels of women undergoing fresh ET at 4 and 8 weeks of gestation were significantly higher than those of the women undergoing frozen ET and the women with NC (P < .01). Serum E2 levels of women undergoing fresh ET at 4 and 8 weeks of gestation were positively correlated to those on the day of human chorionic gonadotropin (hCG) administration (r = 0.5 and r = 0.4, respectively; P < 0.01). The birth weight after fresh ET was significantly lower than that after frozen ET and NC (P < 0.01), with increased incidence of LBW and SGA (P < .05). Furthermore, in the fresh ET group, singletons of mothers with high E2 levels (≥10460 pmol/L on the day of hCG administration) had higher risks of LBW (P < .01) and SGA (P < .01) than those with low E2 levels, and maternal serum E2 level on the day of hCG administration negatively correlated with the birth weight (P < .01). The maternal high-E2 environment in the first trimester is correlated with increased risks of LBW and SGA. Evaluation of serum E2 before ET should be adopted to reduce the possibility of high E2 exposure to gamete/embryo.

The dynamics of serum anti-Mullerian-hormone levels during controlled ovarian hyperstimulation with GnRH-antagonist short protocol in polycystic ovary syndrome and low responders

ObjectiveTo determine whether the decrease in AMH levels during ovarian hyperstimulation for IVF occurs in patients with polycystic ovary syndrome (PCOS) and patients with low ovarian reserve (LOR), as in normal cycling women. Study designA cohort of 22 infertile patients treated in a single tertiary center with a GnRH-antagonist short protocol for IVF were prospectively included and divided into three groups: PCOS with hyperandrogenism (n=7), LOR (n=8) and control (n=7). Serum AMH levels were measured before and during FSH treatment, on the day of HCG administration, at the mid-luteal phase, and 14 days after embryo transfer. The three groups were compared using an ANOVA model in the case of continuous data and with Fisher's exact test when the data were discrete. ResultsIn the PCOS group, AMH levels increased at the beginning of the stimulation, but later decreased, until the mid-luteal stage. In the other two groups, AMH levels decreased throughout ovarian stimulation until the mid-luteal stage. In all groups, AMH levels returned to baseline levels two weeks after HCG administration, regardless of treatment outcome (pregnancy or not). ConclusionsAMH levels decline during controlled ovarian hyperstimulation with a GnRH-antagonist short protocol in women with low and normal ovarian reserves. In contrast, in women with PCOS, an increase in AMH levels precedes this decline. These findings may support the hypothesis that androgens may play a role in AMH regulation in women.

Advancing or postponing the day of human chorionic gonadotropin does not matter for the outcome in assisted reproductive technology.

CONTEXT:The primary outcome is to remove the worry of getting immature oocytes with early administration of human chorionic gonadotropin (hCG).AIM:The aim was to find out the association between the day of hCG administration and follicular response in relation to the number and maturity of oocytes, and fertilization rate in assisted reproduction to avoid weekend oocyte recovery (OR).SETTINGS AND DESIGN:Retrospective study was carried out in the university infertility clinic.MATERIALS AND METHOD:Controlled ovarian hyperstimulation (COH) in 94 patients undergoing assisted reproductive technology (2010-2011) with recombinant follicle stimulating hormone and timely gonadotropin-releasing hormone antagonist were analyzed regarding day of hCG from day 8-11. Oocyte maturity and fertilization was analyzed and correlated with the day of hCG administration.STATISTICAL ANALYSIS:Kruskal–Wallis test.RESULTS:The average number of >18 mm follicles observed from day 8-11 of hCG administration was not statistically different. However, the OR rate (54.2%), number of mature oocytes (92.5%), and fertilization rate (78.5%) was maximum in the patients where hCG was administered on day 8 of COH.CONCLUSIONS:The day of hCG administration between 8 and 11 does not affect the OR rate significantly although the number of oocytes recovered on day 8 are marginally higher compared with day 9-11. Hence, it is possible to safely avoid weekend oocyte retrieval, by delaying or advancing hCG administration without compromising the outcome.

Early Initiation of Gn RH Antagonist versus long agonist Protocols in PCOS Patients Undergoing ICSI Cycles.

AbstractPurpose: To compare the efficacy of early initiation of Gonadotrophin Releasing Hormone (GnRH) antagonist in comparison with the GnRH agonist protocol in Polycystic Ovarian Syndrome (PCOS) patients undergoing Intracytoplasmic Sperm Injection (ICSI) cycles. Materials and methods: Prospective randomized controlled trial. Seventy infertile PCOS patients under 35 years of age coming for the first trial IVF/ICSI treatment at the infertility care unit were included in the study. They were randomized to either GnRH agonist long protocol (control group A) or early initiation of GnRh antagonist (study group B) after pretreatment with OCP. Ovulation was triggered with Humman Chorionic Gonadotrophin (hCG) when at least 3 mature follicles 18 mm were detected. Results: Age, body mass index, duration of infertility, basal Follicle Stimulating Hormone (FSH), Lutinizing Hormone (LH), Estradiol (E2) at the first day of the cycle, the number of oocytes retrived, the total number of embryos, chemical, clinical pregnancy and implantation rates were comparable in both groups and there was no statistically significant difference. The stimulation period was shorter in group B than group A and number of ampoules of gonadotrophins ampoules and Serum E2 level on the day of hCG administration were significantly lower in group B than that of the group A with statistically significant differences. Moderate OHSS was documented in 4 cycles of group A but was not in any cycle of group B and this difference was statistically significant. No cases of severe OHSS were documented in both groups.Conclusions: This novel antagonist protocol may be a safe and efficient treatment for PCOS patients undergoing ICSI cycles with comparable results to the standard long GnRH agonist protocol.

Early Initiation of Gn RH Antagonist versus long agonist Protocols in PCOS Patients Undergoing ICSI Cycles

AbstractPurpose: To compare the efficacy of early initiation of Gonadotrophin Releasing Hormone (GnRH) antagonist in comparison with the GnRH agonist protocol in Polycystic Ovarian Syndrome (PCOS) patients undergoing Intracytoplasmic Sperm Injection (ICSI) cycles. Materials and methods: Prospective randomized controlled trial. Seventy infertile PCOS patients under 35 years of age coming for the first trial IVF/ICSI treatment at the infertility care unit were included in the study. They were randomized to either GnRH agonist long protocol (control group A) or early initiation of GnRh antagonist (study group B) after pretreatment with OCP. Ovulation was triggered with Humman Chorionic Gonadotrophin (hCG) when at least 3 mature follicles 18 mm were detected. Results: Age, body mass index, duration of infertility, basal Follicle Stimulating Hormone (FSH), Lutinizing Hormone (LH), Estradiol (E2) at the first day of the cycle, the number of oocytes retrived, the total number of embryos, chemical, clinical pregnancy and implantation rates were comparable in both groups and there was no statistically significant difference. The stimulation period was shorter in group B than group A and number of ampoules of gonadotrophins ampoules and Serum E2 level on the day of hCG administration were significantly lower in group B than that of the group A with statistically significant differences. Moderate OHSS was documented in 4 cycles of group A but was not in any cycle of group B and this difference was statistically significant. No cases of severe OHSS were documented in both groups.Conclusions: This novel antagonist protocol may be a safe and efficient treatment for PCOS patients undergoing ICSI cycles with comparable results to the standard long GnRH agonist protocol.