hCG Group Research Articles

Dual trigger versus human chorionic gonadotropin trigger for blastocyst quality and cumulative live birth.

To evaluate the difference in the number of euploid blastocysts and cumulative live birth rate (LBR) between dual and human chorionic gonadotropin (hCG) triggers in poor and normal ovarian responders undergoing preimplantation genetic testing (PGT) cycles. This retrospective cohort study was enrolled from July 2018 to December 2021 and followed up until June 2024 at a single reproductive medical center. Overall, 1040 in vitro fertilization (IVF)-PGT and 784 frozen-thawed embryo transfer (FET) cycles were assessed. Dual (triptorelin acetate 0.2 mg and recombinant hCG [rhCG] 250 µg) or hCG (rhCG 250 µg) trigger was used for oocyte maturation in the gonadotropin-releasing hormone antagonist protocol and PGT cycles. We assessed the embryo outcomes and FET cumulative pregnancy outcomes. The number of oocytes retrieved (10.17 ± 5.22 vs 10.27 ± 5.14, P = 0.789), MII oocytes (8.24 ± 4.26 vs 8.28 ± 4.05, P = 0.888), blastocysts (2.16 ± 1.50 vs 2.12 ± 1.49, P = 0.729), euploid blastocysts (1.06 ± 1.14 vs 1.09 ± 1.23, P = 0.726), and the rate of cumulative LBR (24.9% vs 24.9%, P = 1.000) in the dual trigger group were comparable with those in the hCG group. The trigger method was not correlated with higher LBR based on logistic regression analysis (odds ratio[OR] = 1.040 [0.778-1.392], P = 0.790). For poor and normal ovarian responders, the dual trigger, compared with the hCG trigger, did not improve the PGT embryo outcomes and FET cumulative pregnancy outcomes.

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.

P-421 Enhancing the success of frozen embryo transfer by human chorionic gonadotropin injection on the day of progesterone supplementation onset - a machine learning study

Abstract Study question Does subcutaneous injection of human chorionic gonadotropin (hCG) at the onset of progesterone supplementation affect clinical pregnancy rate in frozen embryo transfer cycles? Summary answer Clinical pregnancy rates are higher when hCG injection is administered at the onset of 300 mg/day progesterone in patients undergoing frozen embryo transfer. What is known already HCG and progesterone play crucial roles in embryo transfer and implantation during in vitro fertilization. Exisitng studies have demonstrated that pre-administration of hCG at the onset of progesterone supplementation for frozen embryo transfer increases clinical pregnancy rates in patients with endometriosis. However, the synergistic effects of hCG and progesterone co-supplementation in a broader range of patients remain unexplored and require further investigation. A multifactorial analysis of hormone replacement therapy, covering various patient-specific aspects, is necessary to understand the implications of this approach. Study design, size, duration This retrospective cohort study analyzed data from 2,251 single frozen embryo transfers performed between Jan 2019-Aug 2023 at the INVICTA Fertility Centre, Poland. The dataset was selected by the practitioner and included age, AMH, BMI, embryo morphology grade, total number of transfers, medical and embryological procedures, recurrent implantation failure, preimplantation genetic testing, endometrial thickness before transfer (≥ 7 mm), and the menstrual cycle day on which progesterone was started. Participants/materials, setting, methods Patients (21-47 years) receiving 300 or 600 mg/day progesterone for five days were divided into the control and hCG (6,500 IU hCG injection on progesterone onset) groups. A machine learning model was trained using a gradient boosting technique (100 decision trees, four leaves, maximum depth of two nodes, learning rate of 0.05) to identify factors affecting the clinical pregnancy rate. Statistical analysis was performed to compare clinical pregnancy rates between the groups. Main results and the role of chance Our machine-learning model revealed that hCG injection (512 processes vs. 1739 processes without it) at the onset of progesterone administration is an important feature for the clinical pregnancy rate. The performance accuracy of the model was approximately 70%. Of the 1,294 protocols where patients received 300 mg/day progesterone, 311 included hCG injection while 983 did not. The clinical pregnancy rate was significantly higher in the hCG group than that in the control group (54% vs. 46%, P &amp;lt; 0.05), with 167 clinical pregnancies observed in patients receiving hCG injections against 452 pregnancies without it. In contrast, among the 957 protocols where 600 mg/day progesterone was administered, the previously observed effect was not significant (P &amp;gt; 0.05). Comparing 201 processes with hCG injection to 756 processes without it, the incidence of clinical pregnancies was 46.8% and 47.2% (with 94 and 357 confirmed pregnancies), respectively. Other factors such as the morphology grade of the embryo used for transfer, patient’s age, AMH, BMI, total number of transfers performed on the patient, menstrual cycle day on which progesterone was started, occurrence of recurrent implantation failure, and the use of preimplantation genetic testing were not significantly different between the groups. Limitations, reasons for caution This study focused on frozen embryo transfers and validation across other protocols using fresh embryo transfers, and different doses or routes of hCG and progesterone administration are needed. The impact of hCG administration on patients with various causes of infertility should also be explored. Wider implications of the findings Pre-administration of hCG injection along with a daily dose of 300 mg/day progesterone enhanced clinical pregnancy rates for frozen embryo transfer. This holds the potential for the optimization of hormon supplementation protocols to increase overall success rates in assisted reproductive technologies. Trial registration number not applicable

In vitro matured oocytes have a higher developmental potential than in vivo matured oocytes after hormonal ovarian stimulation in Callithrix jacchus

BackgroundThe common marmoset, Callithrix jacchus, is an invaluable model in biomedical research. Its use includes genetic engineering applications, which require manipulations of oocytes and production of embryos in vitro. To maximize the recovery of oocytes suitable for embryo production and to fulfil the requirements of the 3R principles to the highest degree possible, optimization of ovarian stimulation protocols is crucial. Here, we compared the efficacy of two hormonal ovarian stimulation approaches: 1) stimulation of follicular growth with hFSH followed by triggering of oocyte maturation with hCG (FSH + hCG) and 2) stimulation with hFSH only (FSH-priming).MethodsIn total, 14 female marmosets were used as oocyte donors in this study. Each animal underwent up to four surgical interventions, with the first three performed as ovum pick-up (OPU) procedures and the last one being an ovariohysterectomy (OvH). In total, 20 experiments were carried out with FSH + hCG stimulation and 18 with FSH-priming. Efficacy of each stimulation protocol was assessed through in vitro maturation (IVM), in vitro fertilization (IVF) and embryo production rates.ResultsEach study group consisted of two subgroups: the in vivo matured oocytes and the oocytes that underwent IVM. Surprisingly, in the absence of hCG triggering some of the oocytes recovered were at the MII stage, moreover, their number was not significantly lower compared to FSH + hCG stimulation (2.8 vs. 3.9, respectively (ns)). While the IVM and IVF rates did not differ between the two stimulation groups, the IVF rates of in vivo matured oocytes were significantly lower compared to in vitro matured ones in both FSH-priming and FSH + hCG groups. In total, 1.7 eight-cell embryos/experiment (OPU) and 2.1 eight-cell embryos/experiment (OvH) were obtained after FSH + hCG stimulation vs. 1.8 eight-cell embryos/experiment (OPU) and 5.0 eight-cell embryos/experiment (OvH) following FSH-priming. These numbers include embryos obtained from both in vivo and in vitro matured oocytes.ConclusionA significantly lower developmental competence of the in vivo matured oocytes renders triggering of the in vivo maturation with hCG as a part of the currently used FSH-stimulation protocol unnecessary. In actual numbers, between 1 and 7 blastocysts were obtained following each FSH-priming. In the absence of further studies, FSH-priming appears superior to FSH + hCG stimulation in the common marmoset under current experimental settings.

Changes on corpus luteum structure and progesterone synthesis pathway after hCG or GnRH treatment during the early luteal phase in sheep

This study investigated the effect of hCG or GnRH on structural changes of the corpora lutea (CL) and the regulation of the expression of steroidogenic enzymes involved in P4 secretion in post-ovulatory (po-CL) and accessory CL (acc-CL). Sixty-four ewes were assigned to three groups receiving: 300 IU of hCG (hCG) or 4 µg Buserelin (GnRH) or 1 mL of saline solution (Control) on Day (d) 4 post artificial insemination (FTAI). Laparoscopic ovarian were performed on d 4, 14 and, 21 post-FTAI to determine the numbers of CL. Blood samples were collected for serum LH and P4 analysis. On d 14 post-FTAI, both CL were removed from the ovary to determine large luteal cell (LLC) number and to evaluate the expression of steroidogenic enzymes (HSD3B1, STAR, CYP11A1). Only hCG and GnRH treated ewes generated acc-CL. The LLC in both po- and acc-CL were significantly greater in the hCG group compared to GnRH and Control groups (P<0.05). Overall, hCG group showed the greatest immunodetection of HSD3B1and STAR in both po- and acc-CL (P<0.05). rnRNA expression of HSD3B1, STAR and CYP11A1 in the acc-CL tended to be greater in hCG group than in GnRH group (P<0.1). The LH concentration was increased in GnRH group (P<0.05) and P4 concentration was greater in hCG group compared to the other groups (P<0.05). In conclusion, administration of hCG has a notably impact on acc-CL development and the expression of steroidogenic enzymes compared to GnRH treatment in ewes. This leads to elevated P4 concentration and improved luteal function.

Effect of GnRH and hCG Treatment Following a Short-Term Estrus Synchronization Protocol on Ovulation and the Fertility in Merino Ewes, During the Breeding Season

This study aimed to compare the effect of hCG or GnRH administered 36 h following a short-term estrus synchronization treatment on the ovulation time and pregnancy rates of Merino ewes during the breeding season. The estrus cycles of ewes were synchronized with an intravaginal sponge containing 60 mg of medroxyprogesterone acetate for 6 days, and an injection of 400 IU of eCG and 125 µg of d-cloprostenol 24 h before sponge removal. Thirty-six h after the sponge removal, ewes were injected intramuscularly either 1 ml of physiological saline solution (control-group; n=14), 100 IU of hCG (hCG-group; n=14) or 0.004 mg of buserelin acetate (GnRH-group; n=14). The estrus behavior was observed using teaser rams and the ovulation time was monitored using transrectal ultrasonography twice daily for 96 h after the sponge removal. Ewes in estrus were allowed a single mating using fertile rams. Estrus response was higher (P&lt;0.05) in the control group (92.86%) than in the GnRH group (50.00%). The interval from sponge removal to ovulation and from hCG to ovulation were shorter in the control group than in the hCG group (70.55, 80.83 h; 34.55, 44.83 h, respectively, P&lt;0.05). In conclusion, administration of hCG or GnRH at 36 h following a short-term estrus synchronization protocol did not affect estrus behaviors, ovarian findings and pregnancy rates in ewes during the breeding season.

Human Chorionic Gonadotrophin (hCG) induces changes in IFN-pathway and Interferon-Stimulated Genes (ISGs) on the bovine endometrium at Day 18 of pregnancy.

We hypothesized that the hCG modulates the expression of IFNT-pathway and ISGs in bovine endometrium during early pregnancy. The aim of the current study is to evaluate the effect of hCG on IFNT-pathway signals and ISGs expression in endometrial cells. For this, 29 non-lactating cross-bread cows were used in the study and submitted to a 9-day fixed-time artificial insemination (FTAI) protocol. The day of the AI was considered Day 0 (D0), and five days (D5) after the FTAI, the cows were allocated into two groups: Control and hCG group, when a hCG group received a single dose of 2.500UI of hCG. On day 18 after FTAI (D18) cows were slaughtered and endometrial tissue samples were collected. There was no difference between the embryo recovery rate of the cows in C compared to the hCG. The hCG group increased the accessory corpus luteum formation rate. The hCG resulted in greater serum progesterone concentration in the hCG group compared to the C on Day 14. Only the expression of IFNAR2 and STAT1 were upregulated on pregnant cows of the hCG group compared to the C group. The pathway genes (JAK1, STAT2, and IRF9) were not regulated. The mRNA abundance of ISG15, MX1, MX2, and OAS1 was upregulated in pregnant cows for hCG group, compared to C group. The results show that the administration of hCG, 5 days after AI, in addition to increasing the serum progesterone, modulates the expression of IFNT-pathway and ISGs on bovine endometrium on Day 18 of pregnancy.

Comparison of the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions.

To analyze the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions (ARs). A retrospective analysis was conducted on 211 patients with threatened abortion or premature birth who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine between July 2019 and July 2021. The control group (n=57) received ritodrine hydrochloride, while the observation group (n=154) was treated with phloroglucinol. We compared the overall therapeutic efficacy, time to symptom resolution, cessation of uterine contractions, success rate of miscarriage prevention, and full-term pregnancy rate between the two groups. Estrogen levels, including serum progesterone (P), estradiol (E2), and human chorionic gonadotropin (hCG), were measured and compared before and after treatment using ELISA. Additionally, neonatal outcomes, such as birth weight, Apgar scores, and umbilical arterial blood gas parameters [pH value, partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2)], were evaluated and compared between the groups. Finally, the incidence of ARs during treatment was assessed and compared. Compared to the control group, the observation group had higher effective rate of treatment, success rate of miscarriage prevention, and a full-term pregnancy rate (all P<0.05). The times to symptom resolution and cessation of uterine contractions were markedly shorter in the observation group than those in the control group (both P<0.05). After treatment, levels of serum P, E2, and hCG in the observation group were significantly higher than those of the control group (all P<0.05). Additionally, the body weight, Apgar scores, pH value, and PaO2 of the neonates in the observation group were higher, while PaCO2 and the incidence of ARs were lower compared to the control group (all P<0.05). For threatened abortion or threatened premature labor, phloroglucinol is more effective than ritodrine hydrochloride for clinical intervention and treatment.

Effect of human chorionic gonadotropin injection before frozen-thawed embryo transfer: A retrospective cohort study.

The aim of this study is to investigate the effect of human chorionic gonadotropin (hCG) in hormone replacement regimen for frozen-thawed embryos. We performed a retrospective cohort study and included patients who underwent frozen embryo transfer (FET) between January 1, 2020 and May 31, 2022. According to the protocols for the FET cycle, the patients were divided into control (n = 238) and hCG groups (n = 216). The clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate, and ectopic pregnancy rate were compared between the 2 groups. There was a significant difference in clinical pregnancy rate between the hCG and control groups (55.1% vs 45.8%, P = .048). The ectopic pregnancy rate decreased (5.0% vs 6.4%, P = .654), while the live birth rate increased (36.1% vs 29.0%, P = .105) in the hCG group. However, these differences were not statistically significant. The administration of hCG injection in HRT-FET cycles alone was also found to be associated with clinical pregnancy by logistic regressive analysis. HCG injection in the hormone replacement regimen for FET increased the clinical pregnancy rate.

#86 : Use of Triptorelin Versus Human Chorionic Gonadotropin as Ovulation Trigger

Background and Aims: Gonadotropin releasing hormone agonist (GnRH-a) trigger has been shown to be associated with significantly lower risk of moderate or severe ovarian hyperstimulation syndrome (OHSS) when compared among women at high risk of OHSS. However, trigger failure has been shown to occur in 2% of cycles using GnRH-a as trigger. This study aims to review the use of GnRH-a as ovulation trigger. Method: Retrospective review of records in antagonist cycles from an ART unit in a tertiary hospital from 2017-2021 was performed. Follicles were considered mature when they reach [Formula: see text] 15 mm. Ovulation triggered with urinary human chorionic gonadotropin (uhCG) (5000-10000 IU), recombinant hCG (rhCG) 250 mcg, or triptorelin 0.2 mg when there were [Formula: see text] 3 mature follicles. All embryos obtained from cycles using triptorelin were cryopreserved. Outcome including the number of oocytes retrieved, the follicle to oocyte index, ovarian hyperstimulation syndrome were reviewed. Results: 1378 cycles were included. 1089 cycles had uhCG or rhCG as trigger, while 284 cycles had triptorelin as trigger. Women in the triptorelin group were significantly younger with a lower basal follicle stimulating hormone level and a higher antral follicle count (Table 1). In the triptorelin group, the total number of mature sized follicles, estrogen level at trigger, oocytes retrieved, number of blastocysts were significantly higher compared to the hCG group (Table 2). Follicle to oocyte index was significantly higher in the triptorelin group but the proportion of mature oocytes were similar in both groups. There were no cases of trigger failure and OHSS in the triptorelin group, but 30 cases of OHSS, with18 cases early onset, 12 cases late onset, amongst them 10 cases (1%) were severe OHSS) in the hCG group. Conclusion: GnRH-a trigger is a good candidate as ovulatory trigger in women at risk of OHSS without hampering the laboratory outcome.

#50 : Effect of Dual vs. Single (hCG) Trigger in Maturation Rate of Oocytes in ART

Background and Aims: Due to its similar molecular structures and biological activities, human chorionic gonadotropin (hCG) is used as a substitute for luteinizing hormone (LH) in ART. The weaknesses of using hCG as a trigger are the possibility of ovarian hyperstimulation syndrome in high responders and lacked FSH activity which promotes LH receptor formation in luteinizing granulosa cells, nuclear maturation, and cumulus expansion. GnRH agonist (GnRHa) reduces the development of OHSS and induces a physiological surge similar to the natural menstrual cycle. Because of shorter amplitude and duration of GnRHa-induced LH surge, GnRHa-alone trigger results in a higher early miscarriage rate. Combining these two agents; dual trigger increases oocyte maturation with reduced OHSS. Here we present reports in our clinic to differentiate the dual vs. hCG trigger results. Method: We retrospectively analyzed the data from 68 patients who had undergone antagonist protocol from January 2021-January 2023. The final oocyte maturation was undertaken with a dual trigger with GnRHa (Buserelin 0.3 mg) combined with hCG (r-hCG 250 [Formula: see text]g) ([Formula: see text] = 33) or hCG alone ([Formula: see text] = 35). Results: The mean age of both groups was 34 years old. The AMH level of the dual group ranged from 0.06 – 7.17 ng/mL, and in hCG alone group ranged from 0.16 – 12.3 ng/mL. Women in both groups got similar amounts of follicles and MII oocytes; dual group (14.8 and 12.72 vs. 14.9 and 13). The retrieval rate of oocytes was identical in both groups (86.6% vs. 89.9%). However, the maturation rate of dual group was slightly lower than the hCG group (77% vs. 82%), but it was statistically insignificant (independent t-test p 0.99). Conclusion: We showed that dual trigger was not superior to hCG-alone trigger in terms of maturation rate of oocytes. Analysis of larger data is needed to show the real advantages.

Pulsatile Gonadotropin-Releasing Hormone Therapy Is Associated With Better Spermatogenic Outcomes than Gonadotropin Therapy in Patients With Pituitary Stalk Interruption Syndrome

ObjectiveTo compare the effects of combined gonadotropin and pulsatile gonadotropin-releasing hormone (GnRH) therapy on spermatogenesis in patients with pituitary stalk interruption syndrome (PSIS). MethodsMale patients with PSIS (N = 119) were retrospectively studied. Patients received pulsatile GnRH therapy (N = 59) were divided into response and poor-response groups based on luteinizing hormone (LH) levels after 1-month treatment with a cutoff value of 1 or 2 IU/L. Participants with gonadotropin therapy were divided into human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) group (N = 60), and patients with pulsatile GnRH therapy were classified into GnRH group (N = 28) with treatment duration ≥6 months. ResultsThe overall success rates of spermatogenesis for hMG/hCG and GnRH therapy were 51.67% (31/60) vs 33.90% (20/59), respectively. GnRH group required a shorter period to induce spermatogenesis (8 vs 15 months, P = .019). hMG/hCG group had higher median total testosterone than GnRH group [2.16, interquartile range(IQR) 1.06-4.89 vs 1.31, IQR 0.21-2.26 ng/mL, P = .004]. GnRH therapy had a beneficial effect on spermatogenesis compared to hMG/hCG therapy (hazard ratio 1.97, 95% confidence interval 1.08-3.57, P = .026). In patients with pulsatile GnRH therapy, compared with the poor-response group, the response group had a higher successful spermatogenesis rate (5.00% vs 48.72%, P = .002) and higher median basal total testosterone (0.00, IQR 0.00-0.03 vs 0.04, IQR 0.00-0.16 ng/mL, P = .026) with LH = 1 IU/L as the cutoff value after 1-month pulsatile GnRH therapy. ConclusionsPulsatile GnRH therapy was superior to hMG/hCG therapy for spermatogenesis in patients with PSIS. Earlier spermatogenesis and higher concentrations of sperm could be obtained in the GnRH group if patients received therapy over 6 months.

In Vitro Fertilization Outcomes With a Dual Trigger in Normoresponders in Antagonist Cycles.

Objectives To evaluate whether the dual trigger of ovulation with a gonadotropin-releasing hormone (GnRH) agonist and the standard dose of recombinant human chorionic gonadotropin (hCG) (dual trigger) is better than hCG alone in in vitro fertilization (IVF) cycles of patients who responded well to ovarian stimulation. Methods Between January 2013 and December 2021, 5593 antagonist cycles of patients were reviewed. This study included women who had an antral follicle count of 5 or more and exhibited a normoresponse to ovarian stimulation using the GnRH antagonist protocol, as determined by the follicular output rate (FORT).The primary outcome indicators consisted of the quantities of retrieved oocytes and mature oocytes. The secondary outcome markers included live birth rates, clinical pregnancy rates, and continued pregnancy rates. Results A total of 1244 normoresponder women who met the inclusion criteria were identified from the scanned files and subsequently enrolled in the GnRH antagonist protocol. A total of 383 cycles were observed in the group that was given the standard hCG triggerwhile 861 cycles were observed in the group that was given the dual trigger. The number of mature oocytes and top-quality embryos was significantly higher in the dual trigger group. The maturation rate in the hCG group was 74.8%while it was 76.9% in the dual trigger group (p=0.018). The dual trigger group exhibited an ongoing pregnancy rate of 37.6%, whereas the hCG group had a rate of 30.1% (p = 0.02). The dual trigger group exhibited a slightly higher live birth rate (34.3% vs 29.2%, p = 0.11), although this difference did not reach statistical significance. Conclusion Dual trigger of ovulation was superior to hCG alone in terms of the number of mature oocytes yielded, top quality of embryos, maturation rates, andongoing pregnancy in IVF cycles of normoresponders having ovarian stimulation on the GnRH antagonist protocol.

The efficacy of GnRH agonist trigger followed by hCG add-back in normal responders for fresh embryo transfer: a case-control analysis from Vietnam

Aim: to assess the effects of a dual trigger by gonadotrophin-releasing hormone (GnRH) agonist and low-dose human chorionic gonadotropin (hCG) on in vitro fertilization (IVF) outcomes in women with normal ovarian response.Materials and Methods. This case-control analysis comprised 118 patients who responded normally to ovarian stimulation with a GnRH antagonist protocol at Hue Center for Reproductive Endocrinology and Infertility, Vietnam, between January 2018 and October 2019. Recruitment was achieved through case-control matching: a case (with Dual trigger – group A) was paired with control (with hCG trigger – group B) in a 1:1 ratio. The primary markers of success were the retrieval of oocytes and embryological data, the pregnancy rate, and the incidence of ovarian hyperstimulation syndrome (OHSS).Results. 59 patients in group A and 59 women in group B were recruited. Two groups had comparable patient characteristics and ovarian reserve. The initial dose, total dose, duration of gonadotropin administration, and peak of estradiol level were not statistically different across groups. The number of recovered oocytes (10.3 ± 4.2 vs. 10.0 ± 3.3; p = 0.663), mature oocytes (8.6 ± 3.7 vs.8.1 ± 2.8; p = 0.346), and high-quality embryos (56.2 ± 28.9 vs. 59.8 ± 35.9; p = 0.555) was equivalent. Fertilization, clinical pregnancy, and live birth rates were comparable between the dual trigger and hCG groups. In neither group were any occurrences of OHSS seen.Conclusion. Dual trigger may substitute hCG for final oocyte maturation and fresh embryo transfer in patients with normal responses to GnRH antagonist protocol-induced ovarian stimulation without compromising IVF outcomes.

Analysis of relationship between P wave dispersion and diagnosis of pulmonary arterial hypertension and risk stratification

BackgroundThe aim of this study was to measure the P-wave dispersion(PWD) in the ECG of patients with pulmonary arterial hypertension(PAH). MethodsA total of 103 PAH patients were collected, including 55 patients related with congenital heart disease(CHD) and 44 patients with idiopathic pulmonary arterial hypertension(IPAH). In addition, 30 CHD patients without PAH (nPAH-CHD group) and 30 healthy controls (HCG group) were collected as control. Patients in the PAH group were categorized into the low-risk group (30 cases), moderate-risk group (53 cases) and high-risk group (20 cases), followed by comparison of PWD difference between groups. The ROC curve was used to evaluate the diagnostic efficacy of PWD on PAH-CHD and IPAH. ResultsThe levels of PWD and maximum P wave duration(Pmax) in PAH-CHD and IPAH group were significantly higher than those in nPAH-CHD and HCG group (P < 0.05). PWD level was positively correlated with right ventricular end-diastolic diameter(RVD), right atrial end-systolic diameter(RAS), mean pulmonary arterial pressure(mPAP), pulmonary vascular resistance(PVR)(r = 0.407, 0.470, 0.477, 0.423, P < 0.001), and was negatively correlated with systolic displacement of tricuspid valve annulus(TAPSE) level (r = −0.551, P < 0.001). After risk quantification in 103 PAH patients, we found that PWD was significantly different among the low-risk, moderate-risk and high-risk groups (43.89 ± 9.91 vs. 51.29 ± 6.61, 62.15 ± 10.44, P < 0.001). CHD-PAH and IPAH were identified by PWD with a cut off value of 41.5 ms (P < 0.001), and a cut off value of 41.45 ms (P < 0.001), respectively. ConclusionsPWD might be an effective ECG indicator for PAH, which might be used as a relatively economical indicator for PAH patients to assist in early diagnosis, disease severity assessment and prognosis evaluation.

The effect of gonadotrophin-releasing hormone agonist versus human chorionic gonadotrophin trigger on pregnancy and neonatal outcomes in Letrozole-HMG IUI cycles

BackgroundGnRHa and hCG are both used for oocyte maturation and ovulation triggering. However, GnRHa have a shorter half-life than hCG, which leads to luteal phase deficiency. Letrozole (LE) has been found to improve the luteal function. Thus, the choice of triggering strategy can be different in intrauterine insemination (IUI) cycles using LE and human menopausal gonadotropin (HMG). The aim of this study was to compare the pregnancy and neonatal outcomes of patients triggered with GnRHa versus hCG versus dual trigger in LE-IUI cycles.MethodsThis retrospective cohort study included 6,075 LE-HMG IUI cycles between January 2010 and May 2021 at a tertiary-care academic medical center in China. All cycles were divided into three groups according to different trigger strategies as hCG trigger group, GnRHa trigger group and dual trigger group. The primary outcome was clinical pregnancy rate. Logistic regression analysis was performed to explore other risk factors for clinical pregnancy rate.ResultsNo significant difference was observed in clinical pregnancy rate between hCG, GnRHa and dual trigger cycles in LE-HMG IUI cycles (P = 0.964). The miscarriage rate was significantly lower in the GnRHa trigger group, and higher in the dual trigger group, compared with the hCG group (P = 0.045). Logistic analysis confirmed that triggering strategy was associated with miscarriage (aOR:0.427, 95%CI: 0.183–0.996, P = 0.049; aOR:0.298, 95%CI: 0.128–0.693, P = 0.005). No significant differences were observed regarding neonatal outcomes between the three groups.ConclusionsOur findings suggested that both GnRHa and dual trigger can be used to trigger ovulation in LE-HMG IUI cycles, but dual trigger must be used with caution.

P-645 standard- and low-dose dual trigger compared with human chorionic gonadotropin trigger in preimplantation genetic testing cycles

Abstract Study question Standard-dose dual trigger (SDT) and low-dose dual trigger (LDT) could improve the number of oocytes, blastocysts and euploid blastocysts or not compared with hCG trigger. Summary answer LDT increased the number of oocytes and blastocysts but not euploid blastocysts among high ovarian responders, while SDT cannot help poor to normal ovarian responders. What is known already For low and normal responders, hCG trigger was recommended by the ESHRE guidelines for ovarian stimulation for in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) in 2020. For high responders, this guideline recommended gonadotropin-releasing hormone agonist (GnRH-a) as the first-choice treatment. While recent studies showed that SDT could increase the number of oocytes and blastocysts to achieve equivalent or better pregnancy outcomes among poor and normal ovarian responders. And LDT was designed to prevent severe ovarian hyperstimulation syndrome (OHSS) while guaranteeing embryo quality among high responders by previous studies. Study design, size, duration This retrospective cohort study was performed at the Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital from July 2018 to December 2021. A total of 2,649 IVF-PGT cycles involving 2,275 patients were analyzed, of which 2,270 cycles had complete baseline data. A total of 1,131, 715, and 424 cycles were included in the hCG trigger, SDT, and LDT groups, respectively. Participants/materials, setting, methods Patients who were triggered by SDT(triptorelin acetate 0.2 mg and rhCG 250 µg), LDT(triptorelin acetate 0.2 mg and rhCG 125 µg or hCG 2,000 IU), and hCG (rhCG 250 µg) with GnRH-antagonist stimulation protocol in IVF-PGT cycles were enrolled. The number of oocytes retrieved, blastocysts, and euploid blastocysts were compared as primary endpoints. Propensity score matching (PSM) was used to control for confounding factors of retrospective study. Main results and the role of chance The SDT and hCG groups had a comparable number of oocytes retrieved (11.0 [7.0, 16.0] vs. 11.0 [7.0, 15.0], p = 0.580), blastocysts (2.0 [1.0, 3.0] vs. 2.0 [1.0, 3.0], p = 0.517), and euploid blastocysts (1.0 [0.0, 2.0] vs. 1.0 [0.0, 2.0], p = 0.383) after PSM. LDT increased the number of oocytes retrieved (19.0 [14.0, 25.0] vs. 16.0 [12.0, 21.0], p &amp;lt; 0.001) and blastocysts (3.0 [2.0, 6.0] vs. 3.0 [2.0, 5.0], p = 0.001), but not euploid blastocysts (2.0 [1.0, 3.0] vs. 1.0 [1.0, 3.0], p = 0.111), compared with the hCG trigger after PSM. Limitations, reasons for caution This was a single-center retrospective cohort study. The baseline characteristics of SDT and LDT differed from those of the hCG group because of clinical decision preferences. PSM was used to control for these effects and generate a balanced cohort. Pregnancy outcomes after embryo transfer has not been assessed yet. Wider implications of the findings The hormone change curve induced by LDT is more similar to the natural cycle. Probably LDT could also benefit poor to normal ovarian responders in IVF/ICSI cycles. And LDT might help in fresh embryo transfer cycles because of its advantage on endometrial receptivity. Trial registration number the National Natural Science Foundation of China (Grant No.82171626)

Does dual trigger improve euploidy rate in normoresponder? A cross-sectional study.

With the introduction of the dual triggering-gonadotropin-releasing hormone (GnRH) analog and recombinant human chorionic gonadotropin (hCG) combination, women with a history of low mature oocyte proportion and empty follicle syndrome were shown to benefit from the dual trigger. To investigate whether dual triggering of oocyte maturation with a GnRH agonist (GnRHa) combined with hCG can affect the euploidy rate and improve in vitro fertilization outcomes for normoresponder women. In this cross-sectional study, 494 women who underwent controlled ovarian stimulation with hCG (n = 274) or dual triggering (hCG+GnRHa, n = 220) at Acibadem Maslak hospital, Assisted Reproductive Unit, from January 2019-2022 were enrolled in this study. Preimplantation genetic testing for aneuploidy was performed on all participants. Both groups had similar baseline and clinical characteristics. Of the 881 embryos biopsied, 312 (35.4%) were reported as euploid in the hCG trigger group; in the dual trigger group, 186 (29.8%) of 623 screening embryos were reported as euploid. The hCG group had a higher euploidy rate per biopsied embryo, although the difference was not statistically significant (31.4 26.5 vs. 26.5 33.3, p 0.05). In normoresponders, adding GnRHa for final follicular maturation to hCG did not improve the euploidy rate.

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.

The effect of Parkin gene S/N 167 polymorphism on resting spontaneous brain functional activity in Parkinson's Disease

BackgroundGenetic susceptibility plays a significant role in Parkinson's disease (PD) development. Carriers of the Parkin S/N167 mutation may have an increased risk of PD and altered spontaneous brain activity. ObjectiveThis study aims to investigate the potential pathogenesis of PD through a comparative analysis of the amplitude of low-frequency fluctuations (ALFF) in resting-state functional magnetic resonance imaging (rs-fMRI) of subjects with Parkin gene S/N 167 polymorphisms, and to examine the association between spontaneous brain activity and clinical scale scores of PD. MethodsA total of 69 PD patients and 84 healthy controls (HC) were included in the study. Each subject was genotyped for the Parkin gene S/N 167 polymorphism and underwent rs-fMRI scans. ALFF analysis was employed to evaluate the relationship among genotypes, interactive brain regions, and clinical symptoms in PD. ResultsPD patients exhibited decreased ALFF values in the right anterior lobe and vermis of the cerebellum compared to HC. No significant interaction was found between the gene's main effect and the “group × genotype” effect on brain ALFF values. One-factor ANOVA revealed no significant difference in ALFF values between PD subgroups; however, the ALFF values in the right anterior lobe and vermis of the cerebellum were lower in the PD-G and PD-GA groups compared to the HC-G and HC-GA groups. Spearman correlation analysis demonstrated that ALFF values in the PD-GG and PD-GA groups were negatively associated with UPDRS-III scores in the bilateral lingual gyrus (Lingual R/L). ConclusionParkin gene S/N 167 polymorphisms may influence brain functional activity in specific brain regions, and ALFF values are associated with motor symptoms in PD patients.