Dose Of hCG Research Articles

Luteinizing hormone supplementation with human menopausal gonadotropin versus low dose human chorionic gonadotropin during ovarian stimulation does not affect live birth rates after fresh and frozen embryo transfer.

Luteinizing hormone (LH) plays an important role in ovarian follicle maturation. Human menopausal gonadotropin (hMG) or low dose human chorionic gonadotropin (hCG) can provide LH supplementation during in vitro fertilization (IVF) ovarian stimulation, though studies directly comparing their impact on IVF outcomes are limited. The aim of the study was to determine whether LH supplementation with hMG versus low dose hCG during IVF stimulation affects live birth rate. Fresh and frozen embryo transfers (ET) from 2017 to 2021 after standard long or antagonist protocols supplemented with hMG (75-250 IU) or low dose hCG (50-100 IU) during stimulation cycles in our academic center were included. Statistical analysis was performed with T-tests, Mann-Whitney U tests, Chi-square, and multiple linear and logistic regression. Four hundred and sixty eight unique stimulation cycles resulting in 213 fresh and 412 frozen embryo transfers were analyzed. There was a lower mature oocyte yield (10.9 vs. 11.8, p = 0.044) but similar high-quality blastocyst yield (3.6 vs. 3.9, p = 0.11) for hMG vs low dose hCG. Live birth rates per transfer were comparable for fresh (42% vs. 49%, p = 0.24) and frozen (46% vs. 53%, p = 0.45) embryo transfers. Multiple logistic regressions showed no association between supplemental gonadotropin and live birth for both fresh and frozen embryo transfers. Fresh and frozen IVF-ET pregnancy outcomes were comparable after hMG versus low dose hCG supplementation, suggesting flexibility in supplemental LH dosing regimens that may address patient or physician preference or cost concerns.

Effect of Combined Low Dose Human Gonadotropic Hormone, Follicle Stimulating Hormone, and Testosterone Therapy (LFT Regimen) Versus Conventional High Dose Human Gonadotropic Hormone and Follicle Stimulating Hormone on Spermatogenesis and Biomarkers in Men With Hypogonadotropic Hypogonadism

ObjectiveIn male Congenital hypogonadotropic hypogonadism(CHH), it was observed that lower dose human gonadotropic hormone(hCG) can maintain normal intratesticular testosterone(ITT) levels. We propose this study to compare the Low-Dose hCG, follicle stimulating hormone(FSH), and Testosterone(T) [LFT Regimen] to conventional treatment to induce virilization and fertility. DesignThis open-label randomized pilot study was conducted from June 2020 to December 2021. Subjects and outcome measuresCHH were randomly assigned to either the LFT regimen (Group A)-low-dose hCG (500U thrice per week), FSH(150U thrice per week) and T(100mg biweekly) or conventional therapy(GroupB) with high hCG dose(2000U thrice per week) and the same FSH dose. The hCG dosage was titrated to reduce Anti-mullerian hormone(AMH) by 50% and normalization of plasma T in groups A and B, respectively. The primary objective was to compare the percentage of individuals who achieved spermatogenesis between the two groups. ResultsOut of 30 patients, 23(76·7%) subjects achieved spermatogenesis, and the median time was 12(9-14·9)months. There was no difference in achieving spermatogenesis between the two groups (64·3%vs87·5%,p=0·204), and even the median time for spermatogenesis was similar (15monthsvs12months,p=0·248). Both groups had non-significant median plasma AMH at spermatogenesis,[6·6ng/ml(3·3-9·76) vs 4·41ng/ml(2·3-6·47),p=0·298]. Similarly, the median plasma Inhibin B at spermatogenesis between groups were comparable[152·4pg/ml(101·7-198·0)vs149·1pg/ml(128·7-237·3),p=0·488]. ConclusionsA reasonable approach to induce fertility in male CHH is to initiate combination therapy using FSH, low-dose hCG targeting AMH <6·9 ng/ml, along with T to achieve normal range. Monitoring AMH could serve as a proxy indicator of spermatogenesis.

Low Dose hCG Support in Modified Natural Frozen Embryo Transfer Cycles.

What is the effect of a single low-dose recombinant hCG injection after embryo transfer (ET) in letrozole-induced modified natural frozen embryo transfer cycles (mNC-FET)?. An observational study was conducted in the university-affiliated referral clinic between 2022 and 2024. Women aged 18-42 with at least one vitrified blastocyst obtained from the previous cycle(s) were included. Ovulation induction for endometrial preparation was initiated with oral letrozol (5mg/day) for five days. Ovulation was triggered using 6500IU rec hCG sc when the leading follicle > 17mm, endometrial thickness > 7.5mm, and serum progesterone (P) < 1.5ng/ml. All women received 30mg dydrogesterone/day po for additional five-day luteal support. On the 6th day, ET was performed. Based on a quasi-randomized design, a group of women additionally received a half single bolus of (3250IU) rec hCG (sc) on the morning of 3rd day of ET (hCG group). Women who did not receive additional hCG were assigned as controls.One hundred fifty-four women were detected to be eligible for the study among 2150 initiated FET cycles during the period.Demographic data of the groups, including mean women's age, BMI, serum AMH, and infertility etiologies, were comparable in terms of variables. Mean serum progesterone values and the number of transferred embryos were also similar. A significantly higher ongoing pregnancy/started cycle was documented in the hCG group than in controls (46.7% vs 33.6% respectively, p = 0.03*). A single low-dose hCG injection after ET may improve the OPRs of women in letrozole mNC-FET cycles.

HCG Dosage using blood strips as an alternative to quantitative dosage

HCG Dosage using blood strips as an alternative to quantitative dosage

A Subovulatory Dose of Human Chorionic Gonadotropin (hCG) May Sustain Terminal Follicle Development and Reproductive Efficiency during Anestrus in Sheep.

The study tested the hypothesis that a single administration of hCG supports the LH-dependent phase of terminal follicular development in synchronized sheep during anestrus, using eCG as a functional reference. Using a clinical approach, four experiments were designed to achieve the following: (1) Identify the inhibitory influence of anestrus on reproduction efficiency; (2) Assess the potential of hCG to keep functional blood concentrations after a single dose; (3) Characterize the effect of different doses of hCG on reproductive functional markers; (4) To compare the ability of hCG to that of eCG to support follicular development and fertility based on the same markers. The results showed that anestrus seems to affect follicular and luteal function under LH dependency as FSH-dependent markers are not compromised; hCG maintains higher blood concentrations than controls for at least 48 h; hCG improves follicular development and ovulatory rates compared to controls and at standards comparable to a breeding season; and ewes treated with hCG exhibit similar performance to those treated with eCG. Our results conclude that hCG can be used to support follicular function during anestrus in sheep, aiming to perfect its regulation in assisted reproduction.

(192) Evaluating Effect of hCG and hCG+rFSH Therapy on Ejaculation Disorders in Middle-Aged Men: A Case Study

Abstract Introduction The prevalence of various ejaculation disorders affecting middle-aged and older men has gained increasing attention due to their significant impact on quality of life. One of them, Late-Onset Hypogonadism (LOH) syndrome, can result in a decline in overall well-being. Testosterone replacement therapy (TRT) is commonly used to address LOH; however, it presents challenges such as diminishing endogenous testosterone secretion and incomplete symptom relief. Objective This study aimed to investigate the effects of human chorionic gonadotropin (hCG) or hCG plus recombinant follicle-stimulating hormone (rFSH) therapy in patients experiencing ejaculation disorders characterized by low semen volume and decreased pleasure during ejaculation. Methods Four male patients, aged 55 to 59 years, complaining of decreased ejaculatory pleasure and low semen volume, were enrolled in the study. One patient received hCG+rFSH therapy, while three patients received hCG alone. The initial dose of hCG was 5,000 units administered twice a week, and if deemed insufficient, it was increased to three times a week. rFSH was administered at a dosage of 150 units three times a week. Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol (E2) were measured monthly. Anastrozole (1 mg) was added for patients exhibiting elevated E2 levels. Results Case 1: A 58-year-old male. Prior to treatment, testosterone and E2 levels were 4.84 ng/mL and 34.2 pg/mL, respectively. hCG+rFSH therapy resulted in increased testosterone levels (10.2 ng/mL) and elevated E2 levels (109.0 pg/mL) after three months of treatment. Addition of anastrozole resulted in testosterone levels of 10.90 ng/mL and E2 levels of 57.9 pg/mL in the following month. The patient experienced improved sexual desire, increased semen volume, and hair loss as a side effect. Treatment was discontinued after six months. Case 2: A 57-year-old male with diabetes mellitus. Pre-treatment testosterone and E2 levels were 2.19 ng-mL and 21.9 pg/mL, respectively. After changing the hCG dosage to 5,000 units three times a week, testosterone levels reached 5.33 ng/mL and E2 levels increased to 72.8 pg/mL after two months. With the addition of anastrozole four months into treatment, E2 levels were 44.4 pg/mL after five months. The patient reported improved morning erections, increased libido, increased semen volume, and improved glycemic control (HbA1c decreased from 9.0 to 7.0). Case 3: A 55-year-old male. Pre-treatment testosterone and E2 levels were 4.99 ng/mL and 32.3 pg/mL, respectively. In the first month of hCG therapy, testosterone levels increased to 13.6 ng/mL, while E2 levels rose to 75.5 pg/mL. Then, despite testosterone remaining in the 9.0–10.0 ng/mL range, E2 levels increased to 100 pg/mL. With the addition of anastrozole in the fifth month, the patient reported increased semen volume thereafter. Case 4: A 59-year-old male with a history of bipolar disorder. Prior to treatment, testosterone and E2 levels were 2.45 ng/mL and 23.0 pg/mL, respectively. hCG therapy resulted in testosterone levels of 6.71 ng/ml and E2 levels of 51.0 pg/mL after two months. Conclusions This case study highlights the outcomes of hCG or hCG+rFSH therapy in middle-aged men experiencing ejaculation disorders. Disclosure No.

Evaluation of Dual Trigger versus Higher Dose hcg trigger in antagonist protocol for patients with low number of oocytes retrieved per number of follicles

Evaluation of Dual Trigger versus Higher Dose hcg trigger in antagonist protocol for patients with low number of oocytes retrieved per number of follicles

#311 : Intrauterine Administration of Human Chorionic Gonadotropin in Women Undergoing IVF– An Individual Participant Data Meta-Analysis

Background and Aims: Human chorionic gonadotropin (hCG) has been proposed as an intrauterine intervention around embryo transfer period due to its potential to enhance endometrium receptivity and implantation. Existing randomised controlled trials (RCTs) showed inconsistent findings and multiple meta-analyses on this topic showed high unexplained heterogeneity. Individual participant data meta-analysis (IPDMA) is considered the “gold standard” synthesis method due to its ability to standardise and harmonise the data reporting and analysis. In this IPDMA, we aimed to investigate the effectiveness and safety of intrauterine hCG before embryo transfer. Method: We searched Cochrane Gynaecology and Fertility Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO without language restrictions up to November 2022. We included RCTs comparing intrauterine administration of hCG before embryo transfer versus placebo or no intervention in women undergoing IVF. The outcomes were live birth, clinical pregnancy and other fertility outcomes. We invited trial authors to share the de-identified IPD and established the IHABT collaboration. We performed a one-stage IPDMA as the main analysis. Results: Eight RCTs including IPD of 2338 participants were included. These RCTs were conducted in 6 different countries, with a dosage of intrauterine hCG between 500 IU and 1000 IU. In women undergoing IVF, compared to the control group, intrauterine administration of hCG before embryo transfer does not improve live birth rates (7 RCTs, 2245 participants, odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82–1.17) or clinical pregnancy rates (8 RCTs, 2338 participants, OR 1.13, 95%CI 0.89–1.43). There was insufficient evidence of a difference between the two groups on any of the other fertility outcomes. Conclusion: Intrauterine administration of hCG does not improve live birth or clinical pregnancy rates in women undergoing IVF. Therefore, it should not be offered as an IVF add-on in clinical practice.

Effect of the Type of Pituitary Extracts and Dose of Synthetic Hormones HCG and Ovaprim on Some Reproductive Characteristics of the Endogenous Catfish of Cameroon Clarias jaensis (Boulenger, 1909) in a Controlled Environment

Aims: Improve the domestication of Clarias jaensis through fry production in a controlled environment.&#x0D; Place and Duration of the Study: From April to August 2020 in Integrated Aquaculture Common Initiative Group of West in Batie (LN: 5°17'0''-5°18'53'' and LE: 10°17'0''-10°19'31''), Sudano-Guinean altitude zone of West Cameroon.&#x0D; Study Design: 42 females and 15 males of respective weight and size: 177±40.46g, 347.62±111.72g, 29.02±1.74cm and 39.52±12.27cm were used and divided into 7 batches of comparable weights and sizes. Two randomly selected batches were subjected to the female pituitary extract of Clarias jaensis and Toads, five others to the synthetic hormones HCG (doses 3800 and 4000 IU/kg live weight) and Ovaprim (doses of 0.4, 0.5 and 0.6 ml/kg) respectively.&#x0D; Methodology: Eggs were enumerated by direct observation after fertilization. At the end of the hatching (D1) and of vitelline resorption (D3), the larvae of each experimental lot were counted and measured.&#x0D; Results: The mean diameter of the oocytes after induction, the relative and absolute fecundities and the fertility rate were higher in batches treated with the hormone HCG at a dose of 4000 IU/kg (2.12±0.1mm; 29,584±5,19 oocytes/g; 4694±620 oocytes and 80.14±9.78%), the lowest values were obtained with HCG at 3800 IU /kg, Ovaprim at 0.4ml/kg, pituitary toad extract and Ovaprim at 0.5 ml/kg (1.93±0.06mm; 15.29 ± 4.22 oocytes/g; 1410±106 oocytes and 55.34±1.51%). The hatchability rate was higher with Ovaprim at 0.6ml/kg, followed by HCG at 4000 IU/kg, However, no significant differences were observed between treatments (P&gt;0.05)."&#x0D; Conclusion: In a fish farm of intensive production, the use of the hormone Ovaprim dose 0.6 ml/kg or HCG at 4000IU/kg will lead to high results.

Reproductive performance in gilts submitted to non-steroidal therapies to prolong the luteal phase of the estrous cycle

Synchronized cyclicity of replacement gilts is crucial to optimize breeding herd management, however, protocols with oral progestogen are expensive and require daily administration. This study tested two synchronization protocols without progestogens during the luteal phase in gilts. In Experiment I, on the day of the expression of the third estrus (D0), gilts were assigned to three groups (n = 6, each): control, with no treatment; PGF25: in which gilts received two doses of hCG (1,500 IU each) on D12 and D15 and two doses of a prostaglandin F2α (PGF) analogue (sodium cloprostenol; 250 µg) 6-h apart, on D25; and PGF30: in which gilts received two doses of hCG (1,500 IU each) on D12 and D15 and two doses of the PGF analogue (sodium cloprostenol; 250 µg) 6-h apart, on D30. The interval between PGF treatment and estrus expression was shorter in PGF30 than in PGF25 (P < 0.01). The PGF treatment failed to decrease serum progesterone (P4) for gilts from the PGF25 group (P > 0.05), but it was effective for gilts in the PGF30 group (P = 0.01). In Experiment II, gilts were assigned to three groups (n = 12, each): control (no treatment); eCG+hCG (400 IU eCG on D10 plus 500 IU hCG on D12); and hCG2 (two hCG doses, 1,500 IU each on D12 and D15). On D30, gilts from eCG+hCG and hCG2 that did not express estrus received two doses of the PGF analogue (250 µg each, 6-h apart). All gilts were inseminated when estrus was detected. Serum P4 concentrations were similar for all groups on D10 (P > 0.05) and greater on D20 and D25 for gilts in eCG+hCG and hCG2 (P < 0.01) than for those in the control, whereas P4 concentration was greater in hCG2 than in eCG+hCG, on both moments. The inter-estrus interval (IEI) was shorter for control gilts and intermediate for gilts in eCG+hCG, while the longest IEI was observed for gilts in hCG2 (P < 0.01). Total litter size was larger for gilts in the control (P = 0.02) compared to those in hCG2 and did not differ from the other groups for gilts in eCG+hCG (P > 0.05). In conclusion, Experiment I showed that PGF treatment did not induce luteolysis 10 days after the second hCG treatment but it was effective 15 days after the second hCG application. Additionally, Experiment II showed that both eCG+hCG and hCG2 were efficient in prolonging the luteal phase; however, number of piglets born alive and total litter size were negatively affected by the hCG2 protocol. In this sense, treatment with eCG+hCG or hCG2 may represent a steroid-free approach to prolong the luteal phase in gilts, although the doses and number of treatments must be further investigated.

Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments.

Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for the prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-analyses of randomized controlled trials (RCTs) and assess and grade their efficacy and evidence base. The best available evidence for each specific intervention was identified, analyzed in terms of safety/efficacy ratio and risk of bias, and graded using the Oxford Centre for Evidence-Based Medicine (CEBM) hierarchy of evidence. A total of 15 interventions to prevent OHSS were included in the final analysis. In the IVF population not at a high risk for OHSS, follitropin delta for ovarian stimulation may reduce the incidence of early OHSS and/or preventive interventions for early OHSS. In high-risk patients, inositol pretreatment, ovulation triggering with low doses of urinary hCG, and the luteal phase administration of a GnRH antagonist may reduce OHSS risk. In conclusion, even if not supported by systematic reviews with homogeneity of the RCTs, several treatments/strategies to reduce the incidence and severity of OHSS have been shown to be promising.

Comparison between Agonist Trigger with HCG Luteal Phase Supplementation vs HCG Trigger with Progesterone Luteal Phase Supplementation in Antagonist Controlled Hyperstimulation Cycle Regarding Clinical Pregnancy Rate

For the last two decades, exogenous progesterone administration has been used as luteal phase support (LPS) in connection with controlled ovarian stimulation combined with use of the human chorionic gonadotropin (hCG) trigger for the final maturation of follicles. The introduction of the GnRHa trigger to induce ovulation showed that exogenous progesterone administration without hCG supplementation was insufficient to obtain satisfactory pregnancy rates. This has prompted development of alternative strategies for LPS. Augmenting the local endogenous production of progesterone by the multiple corpora lutea has been one focus with emphasis on one hand to avoid development of ovarian hyper-stimulation syndrome and, on the other hand, to provide adequate levels of progesterone to sustain implantation. The present study evaluates the use of micro-dose hCG for LPS support and examines the comparison between conventional HCG trigger and progesterone luteal phase support vs Agnosit trigger and HCG microsdose luteal phase support as regards to pregnancy rate. Methods 100 patients were recruited for this trial Cases with Polycyctic ovaries were excluded from the study. The study was approved by Ethical committee of Ain Shams university. Patients received Gonal-F (Merck Serono S.p.A., Via delle Magnolie 15, I70026 Modugno (Bari), Italy.) in a dose ranginging between 150-300 IU for stimulation and the dose was adjusted according to response starting day 6. Premature LH surge was prevented with 0.25 mg of a GnRH antagonist (Cetrotide; Merck international) starting on day 6, when two or more follicles reach a size of 18–20 mm, patients were randamized into 2 groups of 50 each. Trigger of ovulation was done by a single dose of 0.2 mg triptorelin (Decapeptyl®ferring pharmaceutical company, Germany) and luteal phase support with daily 125 IU HCG injections in Group 1. Group 2 received A single dose of HCG 10000 IU was given followed by progesterone supplementation with 100mg IM progesterone (Prontogest® IBSA Swisserland). 2 Embryo were transferred and an ultrasound at 4 weeks after embryo transfer for cases with positive pregnancy test. As regards to clinical pregnancy group 1 had 28 of the 50 (56%) Positive clinical pregnancy while control was 26 of the 50 (52%), the difference was not statistically significant (P &amp;gt; 0.68). No cases of moderate or severe ovarian hyperstimulation were observed during the study. To conclude, Agonist trigger combined with microdose HCG had a comparable pregnancy rate resulst to HCG trigger and conventional progesterone support for luteal support without increasing the risk of ovarian hyper stimulation.

Highly-Sensitive In Vitro Bioassays for FSH, TSH, PTH, Kp, and OT in Addition to LH in Mouse Leydig Tumor Cell.

We demonstrate here that highly sensitive in vitro bioassays for FSH, TSH, and PTH can be set up in mouse Leydig Tumor Cells (mLTC), in addition to the normal LH/CG bioassay, after they were transfected with expression vectors encoding the corresponding Gs Protein-Coupled Receptors (GsPCR), such as FSHR, TSHR, or PTHR. Although the β2 adrenergic receptor is also a GsPCR, its expression in mLTC led to a significant but very low cAMP response compared to those observed with FSH, TSH, or PTH. Similarly, after transfection of the GiPCR MT1 melatonin receptor, we did not observe any inhibitory effect by melatonin of the LH or hCG stimulation. Interestingly, after transfection of mLTC with the human kisspeptin receptor (hKpR), which is a GqPCR, we observed a dose-dependent synergy of 10-12-10-7 M kisspeptin variants with a fixed concentration of 0.3 nM LH or hCG. Without any exogenous receptor transfection, a 2 h preincubation with OT or AVP led to a dose-dependent cAMP response to a fixed dose of LH or hCG. Therefore, highly sensitive in vitro bioassays for various hormones and other GPCR ligands can be set up in mLTC to measure circulating concentrations in only 3-10 µL of blood or other body fluids. Nevertheless, the development of an LHRKO mLTC cell line will be mandatory to obtain strict specificity for these bioassays to eliminate potential cross-reaction with LH or CG.

P-682 Androgen and Inhibin B levels during ovarian stimulation before and after eight weeks of low dose hCG priming in women with low ovarian reserve

Abstract Study question Does eight weeks of low dose human chorionic gonadotropin (hCG)-priming affect androgen or Inhibin B levels in serum and follicular fluid during IVF/ICSI treatment? Summary answer Inhibin B was reduced on stimulation day 1 in the IVF/ICSI cycle following hCG-priming. Androgen levels in serum and follicular fluid was not increased. What is known already In our recently published pilot study, eight weeks of low-dose hCG-priming was used to stimulate the intraovarian androgen synthesis in women with AMH &amp;lt;6.29 pmol/L. Priming resulted in more retrieved oocytes and more follicles sized 2-5 mm and less sized 6-10 mm at the start of stimulation. Stimulation time and FSH consumption was increased after priming. HCG priming potentially stimulate the intraovarian androgen synthesis causing upregulation of FSH receptors on granulosa cells, and therefore it was unexpected that the antral follicles were smaller and stimulation time longer following priming. This might indicate a different mechanism of action than previously thought. Study design, size, duration A prospective, paired, non-blinded, single-center study including 20 women conducted between January 2021 and July 2021 at a tertiary referral hospital. Participants underwent two identical IVF treatments: a Control cycle including elective freezing of all blastocysts and a Study cycle with fresh blastocyst transfer. The Control and Study cycles were separated by eight weeks (two menstrual cycles) of hCG-priming by daily injections of 260 IE hCG (details in our previously published paper). Participants/materials, setting, methods Women aged 18-40 years with cycle lengths of 23-35 days and AMH &amp;lt;6.29 pmol/L. Control and Study IVF cycles were performed in a fixed GnRH-antagonist protocol. Blood samples were taken on stimulation day 1, stimulation day 5-6, trigger day, day of oocyte pick up (OPU), and trigger day + 7 days in the Control and Study cycles. Follicular fluid was collected from the first aspirated follicle on both sides during OPU in both cycles. Main results and the role of chance Inhibin B serum levels were significantly lower on stimulation day 1 after hCG-priming, but no other significant differences in serum Inhibin B or androgen levels were seen. The concentrations of Inhibin B and androstenedione in the follicular fluid from the Study and Control cycle did not vary but testosterone was significantly lower in the Study cycle. A lower Inhibin B in the Study cycle corresponds with the antral follicles being significantly smaller after priming, and this probably led to a longer stimulation time in the Study cycle. This contradicts the theory that androgen priming causes more FSH receptors on developing (antral up to preovulatory) follicles. Instead, we hypothesize that androgen priming rescued some small antral follicles that would have otherwise undergone atresia by the end of the previous menstrual cycle. The mechanism of action was likely an increase in androgen levels and FSH receptor expression within these small follicles, however, not enough to elevate androgen levels in serum. We retrieved significantly more oocytes in the Study cycle and the production of estradiol per follicle ≥10 mm on trigger day was comparable in the Study and Control cycle, suggesting that the rescued follicles were competent in producing oocytes and steroid hormones. Limitations, reasons for caution The sample size was small, and androgen and Inhibin B levels were not the primary outcome. We have not demonstrated a higher androgen level or FSH receptor expression in small antral follicles following hCG-priming. Wider implications of the findings The results make us question the mechanism of action behind hCG-priming prior to IVF. It is important to design a study with retrieval of small antral follicles immediately after priming to investigate the proposed hypothesis and to confirm improved cycle outcomes i.e., more retrieved oocytes in a larger study population. Trial registration number NCT04643925

A single dose of FSH or hCG during a split-time AI program did not enhance follicular growth or pregnancy per artificial insemination in beef heifers

ABSTRACT The objective of this study was to evaluate the effect of a low dose of hCG or FSH on follicle growth and pregnancy per artificial insemination (AI) in crossbreed beef heifers subjected to a split-time AI program. All heifers (n = 386) were subjected to a 7-d Co-synch protocol and an intravaginal controlled internal drug release (CIDR) device (GnRH and CIDR insertion; 7 days later PGF2α, CIDR removal, and application of a tail head estrus detection patch; 36 hours later AI of heifers detected in estrus, 24 hours later timed AI of remaining heifers). At CIDR removal, heifers were randomly assigned to receive either 150 IU of hCG, 20 mg of FSH, or remained as untreated controls. The diameter of the preovulatory follicle and the pregnancy per AI did not differ among treatments. A smaller (P = 0.035) proportion of heifers in the hCG group were detected in estrus compared with control. Additionally, the incidence of premature ovulation was greater (P < 0.01) among heifers treated with hCG compared with control. In conclusion, using a low dosage of hCG or FSH at the time of device removal did not affect pre-ovulatory follicle growth or the proportion of pregnant heifers.

A combination of GnRH-hCG in aged mares improves embryo recovery

Older embryo donor mares typically have proven offspring, representing the largest population in most embryo transfer programs. However, aged embryo donors typically have poor embryo recovery due to uterine, cervical, and ovarian problems. In addition, older mares are thought to have deficient oocyte nuclear and cytoplasm maturation, leading to poor fertility. It has been proposed that better fertility results from combining LH-like (e.g. hCG) and GnRH-agonists to induce ovulation for potentially different mechanisms of action, as the LH-like molecule would presumably promote better nuclear maturation matching with the cytoplasm. Alternatively, the authors have been using a protocol in clinical practice, which consists of administering low doses of hCG and low doses of GnRH agonists before induction of ovulation to promote oocyte maturation; thus this study was undertaken to assess the usefulness of this protocol by assessing embryo recovery of commercial, aged embryo donor mares with subpar fertility. The study was conducted with six sub-fertile embryo donor mares (20±1.7, ranging 18-23yrs-old). In experiment 1, estrous cycles were assigned as control-cycles (n=13) or deslorelin-hCG cycles (n=12). Control-cycles received saline (0.5mL, i.m., q12h), and deslorelin-hCG cycles received deslorelin (125µg, i.m., q12h) starting when a dominant follicle achieved 20mm, and then once the same follicle achieved 25mm, mares received hCG (500units, i.m., q24h) until the dominant follicle achieved a periovulatorystage (i.e., ≥35mm with uterine edema ≥1). None of the mares received more than four doses of hCG. Then, ovulation was induced with hCG (2,500units). In experiment 2, thirty-cycles of the same mares were randomly assigned to control-cycles (identical to experiment 1, n=19) and histrelin-hCG cycles (n=11), which followed a similar design to experiment 1, except that instead of administering deslorelin, histrelin was given (125µg, i.m.). Ovulation was induced and confirmed by daily monitoring. In both experiments, mares were bred with cooled semen from fertile stallions. Embryo flushing was carried out eight days post-ovulation, and embryos graded. Statistical analyses were carried out with Fisher's exact test. Significance was set as P<0.05. Overall, 25% of cycles did not grow follicles in response to the treatment, double ovulation happened on three-treated-cycles. One mare had double ovulations in the control- and treated-cycles. None of the mares failed to ovulate after hCG. In experiment 1, the embryo recovery was 58.8% (7/12) for deslorelin-hCG cycles vs. 7.7% (1/13) for control-cycles (P<0.05). In experiment 2, the embryo recovery for histrelin-hCG cycles was 72.8% (8/11) in comparison with control-cycles 21% (4/19 cycles; (P<0.05). In conclusion, the results of this field study suggest that a combination of GnRH-agonist and hCG early in the cycle improves embryo recovery in sub-fertile aged mares and that the majority of cycles (75%) will respond to treatment namely grow follicles and ovulate.

Recombinant equine FSH superovulation in the mare

Inducing ovulation of multiple follicles has been an elusive goal in equine reproduction. Administration of porcine FSH, ovine FSH or GnRH agonists only yield a marginal increase in ovulation rate in mares. Early studies utilizing single chain recombinant equine FSH (reFSH) reported stimulation of follicular development in anestrous mares and increased ovulation rates in cycling mares. Unfortunately, the original reFSH product from AspenBio Pharma, Inc. (Castle Rock, CO USA) is no longer in production. The goal of the current study was to evaluate the efficacy of a new single chain recombinant equine FSH (reFSH-FP; FertilPlus Partners, LLC; Conroe, TX USA) in stimulation of follicular development in mares in two pilot studies as compared to the original reFSH (reFSH-AB; AspenBio Pharma). Study 1. Nine seasonally anestrous mares (follicle diameter 19 ± 3.7 mm) were randomly assigned to one of 3 treatment groups (n=3/group): saline placebo, reFSH-AB (0.65 mg, IM, q12), reFSH-FP (0.65 mg, IM, q 12h) for a maximum of 7 days. A dose of hCG (2,500 units, IV) was administered after a 36-hour coast period once one or more follicles attained a diameter of ≥ 35 mm. The ovulation rates for the three treatment groups were 0, 10.3 ± 3.5, and 6.0 ± 2.0 ovulations for the saline placebo, reFSH-AB and reFSH-FP, respectively. Study 2. Twelve normally cycling mares were randomly assigned to one ofthe same treatment protocols as described for Study 1 above (n=4 per group). All mares were in mid-diestrus at the onset of treatment and a dose of cloprostenol (250 µg, IM) was administered on the second day of treatment. Mares were treated for a maximum of 7 days. HCG (2,500 units, IV) was administered after a coast period of 36 hours when one or more follicles attained a diameter of ≥ 35 mm. Ovulation rates were 1.3 ± 0.5, 5.5 ± 5.3, and 5.3 ± 1.0 ovulations for the saline placebo, reFSH-AB and reFSH-FP, respectively. All mares ovulated in the placebo and reFSH-FP groups after administration of hCG; one mare in the reFSH-AB group developed 12 follicles > 35 mm in diameter, but failed to ovulate after administration of hCG. Collectively, these studies confirm that the new recombinant equine FSH product (reFSH-FB; FertilPlus) has biological activity in the mare similar to that of the original reFSH product (reFSH-AB; AspenBio Pharma) and is capable of stimulating development of multiple large follicles in deep anestrus and cycling mares. However, significant hurdles remain before a recombinant equine FSH product could be available for commercial production, distribution and clinical use. Additional research will be needed to evaluate safety, dosage, frequency of administration, timing of administration of an ovulation induction agent, and fertility following reFSH treatment.

Progestin-primed ovarian stimulation for fertility preservation in women with cancer: A comparative study.

In women scheduled for cancer treatment, oocytes cryopreservation is a well-established procedure. Random start protocols have been a substantial improvement in this setting, allowing to prevent delay in the initiation of cancer treatments. However, there is still the need to optimize the regimen of ovarian stimulation, to make treatments more patient-friendly and to reduce costs. This retrospective study compares two periods (2019 and 2020), corresponding to two different ovarian stimulation regimens. In 2019, women were treated with corifollitropin, recombinant FSH and GnRH antagonists. Ovulation was triggered with GnRH agonists. In 2020, the policy changed, and women were treated with a progestin-primed ovarian stimulation (PPOS) protocol with human menopausal gonadotropin (hMG) and dual trigger (GnRH agonist and low dose hCG) Continuous data are reported as median [Interquartile Range]. To overcome expected changes in baseline characteristics of the women, the primary outcome was the ratio between the number of mature oocytes retrieved and serum anti-mullerian hormone (AMH) in ng/ml. Overall, 124 women were selected, 46 in 2019 and 78 in 2020. The ratio between the number of mature oocytes retrieved and serum AMH in the first and second period was 4.0 [2.3-7.1] and 4.0 [2.7-6.8], respectively (p = 0.80). The number of scans was 3 [3-4] and 3 [2-3], respectively (p<0.001). The total costs of the drugs used for ovarian stimulation were 940 € [774-1,096 €] and 520 € [434-564 €], respectively (p<0.001). Random start PPOS with hMG and dual trigger represents an easy and affordable ovarian stimulation protocol for fertility preservation in women with cancer, showing similar efficacy and being more friendly and economical.

Female with peritonitis and abdominal distention.

A G0 35-year-old female with a body mass index (BMI) of 21 and history of antibiotic allergies presented to the emergency department with diffuse abdominal pain. Two days prior, she had a transvaginal ultrasound-guided oocyte retrieval for mature oocyte cryopreservation and 36 hours before the procedure received a human chorionic gonadotropin (hCG) “trigger shot.” She was tachycardic, but otherwise hemodynamically stable. On abdominal examination, she had a distended abdomen with diffuse tenderness to percussion and rebound tenderness. A point-of-care ultrasound demonstrated free fluid and a computed tomography (CT) of the abdomen/pelvis with intravenous contrast was obtained after consultation with surgery and obstetrics (Figures 1-3). CT revealed bilateral enlarged ovaries with follicles, the largest at 17 × 15 × 10 cm, with ascites and bilateral pleural effusions. No free air or active hemorrhage was identified. She underwent paracentesis of 2.5 L with administration of albumin and anticoagulation. Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology, described as cystic enlargement of the ovaries and fluid shifts from the intravascular space to the third space.1, 2 It can occur in 1%–5% of cycles with risk factors of low BMI, polycystic ovarian syndrome, allergy history, high doses of hCG, and large number of follicles.2, 3 Peritonitis can occur because of the release of inflammatory mediators or rupture of follicular cysts.3 Severe OHSS is characterized by ascites, pleural effusions, and hemoconcentration. In addition to OHSS, complications of oocyte retrieval, albeit rare, must also be considered as intraperitoneal hemorrhage, bowel perforation, or infection.4

Frozen-thawed embryo transfer: does the addition of low-dose choriogonadotropin alfa to progesterone in the luteal phase of artificial cycles improve the endometrium and increase the chances of pregnancy?

Primary: To evaluate the effect of low doses of recombinant hCG (choriogonadotropin alfa) in the luteal phase of frozen-thawed embryo transfers (FET) of artificial cycles on the chances of pregnancy in patients aged ≤38years. Secondary: To assess the chances of pregnancy in the FET groups of artificial cycles using micronized vaginal progesterone (VP) versus injectable intramuscular progesterone (IMP) and the chances of pregnancy in type-1 embryo transfers (two top embryos). This retrospective cohort study included 122 cycles of FET and compared two groups of patients aged 38 years or younger, one given hCG in the luteal phase and one not administered hCG. The clinical pregnancy rates (CPR) in the control and hCG groups were 45% and 45.16%, respectively (p=0.9999). The live birth rates (LBR) were 33.33% and 32.25%, respectively, (p=0.99909). The CPR in the VP group (83 patients) was 46.89% versus 41.02% in the IMP group, (p=0.5459). The LBR was 33.73% in the VP group and 30.76% in the IMP group (39 patients), (p=0.7559). The CPR and LBR of patients undergoing FET in groups prescribed and not prescribed low doses of recombinant hCG were similar. No significant difference was found between patients given VP or IMP.