Day Of hCG Injection Research Articles

Successful Pregnancies Following Embryo Transfer Despite Very Thin Late Proliferative Endometrium

Background: A recent published report found no live pregnancies following in vitro fertilization–embryo transfer (IVF-ET) when the maximal endometrial thickness on the day of hCG injection was <7 mm. A search of the English-language literature found two case reports of successful pregnancies with endometria of only 4mm, one following IVF-ET and one with a natural cycle.

Altered vascular endothelial growth factor expression during GnRH antagonist protocol in women of reproductive age with normal baseline hormone profiles

To explain the unexpected low response to GnRH antagonist protocol in reproductive women with normal baseline hormone profiles. Retrospective study. University hospital. Twenty-five women undergoing their first IVF cycle. Follicular fluid (FF) from large follicles (>15 mm) was obtained during oocyte retrieval from unexpected low responders (n = 13, group A) and 12 age-matched normal responders (n = 12, group B). The FF markers known to reflect follicle environment (insulin-like growth factor [IGF] II, IGF-binding protein 4, müllerian-inhibiting substance, pregnancy-associated plasma protein A, soluble Fas, and vascular endothelial growth factor [VEGF]) were analyzed by ELISA. The baseline characteristics (age, day 3 serum LH, FSH, E(2), duration and dose of r-FSH, GnRH antagonist) were not different between the two groups. The number of large follicles, oocytes retrieved, and serum E(2) levels on the day of hCG injection were significantly higher in group B. Whereas the other follicular markers did not differ between the two groups, VEGF was significantly higher in group A. In addition, the VEGF concentration showed an inverse correlation with the total number of oocytes retrieved. The unexpected low response in women with normal basal hormone profiles, during GnRH antagonist protocol, was associated with altered follicular VEGF expression.

Possible metformin effect on adrenal androgens during pretreatment and IVF cycle in women with polycystic ovary syndrome

To determine the effects of metformin treatment on serum androgen levels ahead of and during the IVF cycle in infertile polycystic ovary syndrome (PCOS) women. A prospective, double-blind, placebo-controlled study. Single-center, university IVF clinic. Sixty-three PCOS women. Treatment with metformin 2,000 mg/day or identical placebo tablets for at least 14 weeks before and then during IVF treatment, ending on the day of hCG injection. Serum levels of dehydroepiandrosterone, dehydroepiandrosterone sulphate (DHEAS), androstenedione, free testosterone index (FTI), dihydrotestosterone, and the androgen metabolite 5alpha-androstane-3alpha, 17beta-diol-glucuronide were measured at five time points ending on the day of ovum collection. During metformin pretreatment DHEAS increased, wheres other androgens were unaffected. During the IVF procedure androgens were unaffected by metformin treatment. Within 36 hours after the study medication was withdrawn the levels of androstenedione and FTI increased in the metformin group, whereas DHEAS decreased. In infertile PCOS women metformin treatment increased DHEAS levels. During the IVF cycle androgen levels were unaffected by metformin, whereas there was a "rebound" effect when stopping metformin treatment.

Cytokine profile in cases with premature elevation of progesterone serum concentrations during ovarian stimulation

The aim of this study was to investigate the concentrations of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), leptin, tumor necrosis factor-alpha, interleukin (IL)-1beta and IL-6, in cycles with a premature rise of serum progesterone. 25 intracytoplasmic sperm injection (ICSI) cycles with (Group 1) and 25 ICSI cycles without a premature progesterone elevation (Group 2) were included. The cut-off value of serum progesterone on the day of human chorionic gonadotropin (hCG) administration was 0.9 ng/ml. The indication for ICSI was male factor infertility exclusively. On the day of hCG injection, serum IL-6, VEGF and bFGF were significantly higher in Group 1 (7.7+/-24.5 pg/ml, 290.2+/-161.4 pg/ml and 15.7+/-8.2 ng/ml respectively) than in Group 2 (1.7+/-0.7 pg/ml, 175.2+/-92.1 pg/ml, and 9+/-1.6 ng/ml respectively). On the day of follicular puncture, serum cytokine concentrations were similar in the two groups. IL-6 intrafollicular concentrations were higher in Group 1 (14.7+/-20.7 pg/ml) than in Group 2 (9+/-9.3 pg/ml, p=0.031). There were no differences regarding the ICSI outcome. Patients with serum progesterone above 0.9 ng/ml, have elevated serum concentrations of IL-6, VEGF, and bFGF, as well as elevated intrafollicular concentrations of IL-6. The outcome of ICSI cycles is not associated with premature elevation of progesterone when the cut-off value is set at 0.9 ng/ml.

First intention IVF protocol for polycystic ovaries (PCO): should we prefer dual suppression? preliminary results of a randomized study

First intention IVF protocol for polycystic ovaries (PCO): should we prefer dual suppression? preliminary results of a randomized study

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound examination performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1–3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B (P 0.05). Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.

Subtle progesterone rise in the single-dose gonadotropin-releasing hormone antagonist (cetrorelix) stimulation protocol in patients undergoing in vitro fertilization or intracytoplasmic sperm injection cycles

A subtle rise in serum progesterone during the late follicular phase in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles is a frequent event that can decrease implantation and pregnancy rates in controlled ovarian hyperstimulation (COH) protocols that use a gonadotropin-releasing hormone (GnRH) antagonist. The aim of the present study was to evaluate the prevalence and effect of the subtle progesterone rise during COH with single-dose GnRH antagonist in combination with clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in IVF or ICSI cycles. Ninety-five women undergoing COH with CC, hMG and a single 2.5 mg dose of the GnRH antagonist, cetrorelix, were enrolled in the study. Patients were grouped according to serum progesterone level on the day of human chorionic gonadotropin (hCG) administration (P < 1.2 ng/ml or P ≥ 1.2 ng/ml). The incidence of a subtle progesterone rise was 54.7% (52/95). The group with P ≥ 1.2 ng/ml had significantly higher serum levels of luteinizing hormone (p = 0.002) and estradiol (p < 0.001) on the day of hCG injection than the group with P < 1.2 ng/ml, and more oocytes were retrieved (p = 0.001). However, there was no significant difference in fertilization, clinical pregnancy or implantation rate between the two groups. In conclusion, a subtle progesterone rise during the late follicular phase is common but not associated with pregnancy outcome.

Dexamethasone As a Supplement for Exogenous Gonadotropin to Improve Ovarian Response of Women over 35 Years Undergoing IVF/ICSI Cycles

Background: With aging, the ovarian reserve is decreased and that is a major contributor to poor ovarian response to exogenous gonadotropins. The aim of the present study is to evaluate the role of Dexamethasone on ovarian response in infertile patients aged over 35 years undergoing IVF/ ICSI cycles. Materials and Methods: In this triple blind placbo-control clinical trial study, a total of 72 infertile women over age 35, undergoing IVF/ICSI cycles, referred to Royan Institute from May 2000 to May 2002 were selected. Dexamethasone co-treatment (1mg/d) was started on the 21st of their preceding menstrual cycle and it was continued until oocyte aspiration. The main outcome measures were number of retrieved oocytes, number of fertilized and transferred embryos, number of used HMG, serum E2 level on HCG injection day, and pregnancy rate. Results: There was no significant statistical difference in age, duration of infertility, Body mass index, hormonal tests, number of retrieved oocytes and transferred embryos. However, the number of used HMG was significantly lower in Dexamethasone group compared to placebo group (30.6±13.39 versus 41.64 ± 18.34) (p<0.05). Conclusion: The addition of dexamethasone 1mg/d to standard long protocol decreased the number of HMG used in patients over 35 years who hold known risk of low ovarian response.

Estradiol production by preimplantation blastocysts and increased serum progesterone following estradiol treatment in llamas

Estradiol is a potential candidate for the blastocyst signal responsible for maternal recognition of pregnancy in the llama ( Lama glama). Two experiments were conducted to determine if the llama blastocyst produces estradiol during the presumed period of maternal recognition of pregnancy and if exogenous estradiol can extend the luteal phase. In Experiment 1, llamas were superovulated with eCG and mated 7 days later (Day 0 = day of mating). Blastocysts were collected nonsurgically on Days 7, 9, or 11 or at necropsy on Days 13 and 15 post-mating and cultured for 48 h. Conditioned medium was recovered, replaced with fresh medium at 24-h intervals, and assayed for estradiol-17β. Estradiol production (pg/blastocyst) over the 48-h culture increased ( P < 0.05) by day of gestation where more estradiol ( P < 0.05) was produced by Day 11 compared to Day 7 blastocysts, Day 13 compared to Days 7–11 blastocysts, and Day 15 compared to Days 7–13 blastocysts. A dramatic increase was observed between Days 11 and 13 when estradiol production by Day 13 blastocysts increased ( P < 0.05) more than 50-fold. In Experiment 2, 30 females were induced to ovulate with hCG (Day 0 = day of hCG injection). Starting on Day 7 and continuing through Day 15, animals received daily injections i.m. of 0 ( n = 11), 5 ( n = 7), or 10 mg ( n = 12) estradiol benzoate (EB) dissolved in isopropylmyristate. Sera were collected immediately prior to each injection and on Days 16, 17, 18, 20, and 22 and analyzed for progesterone. Progesterone concentrations were greater ( P < 0.05) on Days 14, 15, 16, and 17 in llamas treated with 10 mg EB compared to llamas treated with 0 mg EB. These results demonstrate that llama blastocysts produce estradiol and exogenous estradiol can enhance and transiently extend luteal progesterone production. Estradiol produced by the preimplantation llama blastocyst may play a role in maternal recognition of pregnancy and early luteal support.

P-732: Predictors of pregnancy in subjects treated with in-vitro fertilization (IVF) and who had a maximum day 3 serum FSH level that was 10 to 11.9 mIU/mL

P-732: Predictors of pregnancy in subjects treated with in-vitro fertilization (IVF) and who had a maximum day 3 serum FSH level that was 10 to 11.9 mIU/mL

P-760: Evidence that high serum progesterone (P) levels on day of human chorionic gonadotropin (hCG) injection have no adverse effect on the embryo itself as determined by pregnancy outcome following donor embryo transfer

There is evidence that a premature rise in P on the day of hCG injection has an adverse effect on pregnancy rates following in vitro fertilization-embryo transfer (IVF-ET). The objective of the present study was to determine pregnancy outcome in recipients according to the P level of the donor at the time of hCG injection. Lower pregnancy rates with advancing P levels would suggest that the adverse effect of P is on the embryo itself. No adverse effect at most levels of elevated P would suggest the adverse effect was on the endometrium.

Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and intrauterine insemination

To evaluate the association between obesity and the outcome of superovulation and intrauterine insemination (IUI) in infertile ovulatory women. Retrospective chart review. University-based infertility clinic. Three hundred thirty-three ovulatory women, grouped by body mass index (BMI) categories, who received superovulation and IUI for treatment of infertility. None. cycle fecundity. total dose of gonadotropins, serum level of E(2), and number of follicles >or=17 mm on the day of hCG injection. Adjusted cycle fecundity was not different among BMI groups (underweight: 0.14 [95% CI: {0.07, 0.29}], normal weight: 0.12 [95% CI: {0.09, 0.16}], overweight: 0.17 [95% CI: {0.12, 0.24}], and obese: 0.14 [95% CI: {0.08, 0.23}]). Adjusted total gonadotropin dose (IU/cycle) was greater in obese women than in underweight or normal-weight women. Although the numbers of large follicles were not different, E(2) levels (pg/mL) were lower in obese women than in normal-weight and overweight women. Our sample of ovulatory infertile women demonstrated that treatment-related cycle fecundity is unaffected by obesity. We conclude that obese, infertile ovulatory women require a greater dose of gonadotropins to achieve similar levels of superovulation than normal, underweight or overweight women.

Outcome of in vitro fertilization-embryo transfer in treatment of polycystic ovarian syndrome

To evaluate the outcome of in vitro fertilization embryo transfer (IVF-ET) in treatment of polycystic ovarian syndrome (PCOS) with infertility. A retrospective analysis was performed from 52 patients with PCOS (PCOS group) and 408 cases with tubal infertility (control group). Both groups underwent IVF-ET treatment from 2001 to 2004. The duration of stimulation, amps of gammaFSH, the level of serum E2, P on the day of HCG injection, the number of oocytes retrieved, the rates of fertilization, cleavage, implantation and pregnancy, the incidence of ovarian hyperstimulation syndrome (OHSS) and cancelled rate of ET were compared between the two groups. The duration of stimulation and amps of gammaFSH were not significantly different between the two groups. The concentration of serum E2, P on the day of HCG injection, the numbers of oocytes retrieved and cleavaged embryos were significantly higher in PCOS group (P <0.01, <0.05). Fertilization rate was significantly lower in PCOS group (P <0.01). The implantation, pregnancy and miscarriage rates per ET were not statistically significant. The OHSS rates and cancelled rates of ET were higher in PCOS group (P <0.01). Women with PCOS have a lower fertilization rate compared with those with tubal-factor fertility during IVF-ET. However, more oocytes are recovered and the preimplanted embryo has a normal chance of implantation leading to similar pregnancy rates. The OHSS rates and cancelled rates of ET are higher in PCOS because of a greater number of oocytes developed and a higher level of E2.

Ovarian response to gonadotropins after laparoscopic salpingectomy or the division of fallopian tubes for hydrosalpinges

To compare the effect of prophylactic laparoscopic salpingectomy versus division of the fallopian tubes on ovarian response to gonadotropins in women undergoing IVF. Retrospective study. National Health Service-based tertiary referral center for reproductive medicine. One hundred sixty-eight women with tubal factor infertility. Sixty-five women with hydrosalpinges had either salpingectomy (n = 40, group A) or proximal tubal division (n = 25, group B), while the remaining women with tubal disease but without hydrosalpinges acted as the control group (n = 103, group C). Prophylactic laparoscopic salpingectomy or proximal division of the fallopian tubes and ovarian stimulation with gonadotropins for IVF. Day 2 serum FSH levels before surgery and 3 months after surgery but before ovarian stimulation, ovarian response assessed as total dose of hMG administered, serum E2 concentrations on day 3 and day 8 of stimulation and on the day of hCG injection, number of follicles, and number of oocytes retrieved and fertilized. In group A, baseline FSH levels were significantly raised after surgery compared with before surgery. Postsurgery FSH concentrations were significantly higher in group A compared with group B. The number of follicles (15-20 mm) was significantly lower in group A compared with group B and group C. The serum E2 levels on day 8 of stimulation were lower in group A compared with group B, and on the day of hCG injection it was significantly reduced in group A compared with groups B and C. The number of oocytes retrieved per cycle was significantly lower in group A compared with group B. There were no significant differences in pregnancy rates and miscarriage rates among the three groups. These findings suggest that prophylactic salpingectomy in women with hydrosalpinx may compromise ovarian response to stimulation without affecting pregnancy rates. A randomized control trial is recommended to determine the most appropriate laparoscopic procedure in the management of hydrosalpinx before IVF.

P-12: The Association of the Percentage Rise in Serum Estradiol (E2) the Day After Human Chorionic Gonadotropin (hCG) Injection and Pregnancy Outcome Following In Vitro Fertilization-Embryo Transfer (IVF-ET) in Normal Responders

Background and Significance: The possibility exists that even in women who appear to respond normally to controlled ovarian hyperstimulation (COH) as manifested by an adequate serum E2 on the day of hCG injection and adequate number of mature follicles, that pregnancy outcome could be related to the follicular response after hCG injection. Theoretically, an adverse outcome could be related to too little of a response or too much.

Effects of recombinant human luteinizing hormone supplementation on ovarian stimulation and the implantation rate in down-regulated women of advanced reproductive age

To evaluate the effects of recombinant human luteinizing hormone (rhLH) supplementation on ovarian stimulation and implantation rate in down-regulated women of advanced reproductive age. Prospective randomized study. University teaching hospital. A total of 120 consecutive normogonadotropic infertile women > or = 35 years old undergoing their first cycle of IVF or intracytoplasmic sperm injection (ICSI) treatment. Ovarian stimulation in a long agonist protocol with a combination of recombinant human follicle-stimulating hormone (rhFSH) and rhLH (group 1, n = 60) starting on day 6 of FSH stimulation until hCG at a daily fixed dose of 150 IU of rhLH, or with rhFSH alone (group 2, n = 60). Ovarian stimulation characteristics, ovum retrieval, and IVF/ICSI outcome. The mean number of intermediate (10-14 mm) and large (> 14- < 18 mm) but not leading (> or = 18 mm) follicles was significantly lower in group 1 on the day of hCG injection. The oocyte yield and maturity as well as the number of oocytes fertilized were significantly higher in group 2 than in group 1. However, the number of patients having embryo transfer (n = 55 in both treatment groups), the number and quality of embryos replaced, the implantation rate (20.6% vs. 21.7%) and clinical pregnancy rates per embryo transfer (44% vs. 45%) were similar in groups 1 and 2. The rhLH supplementation does not increase ovarian response and implantation rates in patients of older reproductive age stimulated with rhFSH under pituitary suppression for assisted reproductive technologies (ARTs).

Follitropin Beta Administered by a Pen Device in Patients Undergoing Controlled Ovarian Hyperstimulation for IVF-ET

OBJECTIVE: To compare the efficacy and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin alpha solution in patients undergoing controlled ovarian hyperstimulation (COH) for IVF-ET. DESIGN: A prospective, randomized study. MATERIALS AND METHODS: A total of 100 patients who were scheduled for IVF-ET, with or without intracytoplasmic sperm injection (ICSI) were enrolled in this study. All subjects were randomized to the pen device group or the conventional syringe group by a computer-generated randomization list using random numbers on a first day of COH. Local tolerance reactions were assessed and filled in a local tolerance book within 5 min, at 1 and 3 hr after each injection. On the day of hCG injection, patients were asked to rate the pain and convenience experienced by means of a visual analogue scale (VAS). Oocyte pickup was scheduled 35-36 hours after hCG administration, and embryos were transferred 3 days after oocyte pickup. RESULTS: There were no differences in age, body mass index (BMI), infertility duration, endocrine profile and indications for IVF-ET/ICSI between the two groups. The duration of COH with recombinant FSH (rFSH) was significantly shorter in the pen device group than in the conventional syringe group (8.7 1.1 vs 9.3 1.3 days)(P 0.05). Patients included in the pen device group needed significantly less rFSH with 2091.0 318.8 IU compared with 2248.0 405.0 IU in the conventional syringe group (P 0.05). However, no differences between the two groups were found in numbers of oocytes retrieved, mature oocytes, fertilized oocytes and grade I/II embryos, clinical pregnancy rate and miscarriage rate. The prevalence of pain after the daily injection was significantly lower in the pen device group (P 0.05). VAS scores were significantly less painful and more convenient for the pen device (P 0.05, P 0.00l, respectively). CONCLUSION: The pen device for self-administration of follitropin beta is effective, safe, less painful and more convenient for the patients, and can be more beneficial because of the short-term and small dose application of rFSH. Supported by: Organon grant 2003-0219

Inversion Ratio of Gonadotropins Activity in Ovulation Induction in Women at Risk of Developing Ovarian Hyperstimulation Syndrome: Preliminary Results

Ovarian hyperstimulation syndrome (OHSS) is a potential life-threatening complication of treatment for infertility. The purpose of this study was to evaluate a protocol of ovarian stimulation in women at risk of developing OHSS, performing the inversion ratio of FSH/LH activity in the mid-follicular phase, through the use of LH activity in the form of low-dose hCG. Case series in a tertiary care center. Seven patients having their first cycle of in-vitro fertilization cancelled because of high risk at developing OHSS (> 30 follicles, E2 > 5,000 pg/mL) were included in this study. Ovarian stimulation was performed with recombinant FSH, 150 IU daily, commencing on day 2 after spontaneous or progestagen-induced withdrawal bleeding. Ovarian response was monitored by pelvic ultrasonography and daily blood samples. When the leading follicle had a size of at least 13 mm, we performed the inversion ratio of FSH/LH activity, by switching the stimulation from recombinant FSH to hCG alone, at the dose of 200 IU intramuscularly daily. At this moment the GnRH antagonist, 0.25 mg cetrotide subcutaneously once daily, was added to the stimulation regimen. When at least three follicles > 17 mm had developed, final oocyte maturation was triggered with 5,000 IU of hCG intramuscularly. Follicular aspiration was performed 35-36 hours later. The outcomes were evaluated in terms of cancellation rate, estradiol concentrations on the day of hCG injection to trigger oocyte maturation, number of mature oocytes retrieved, fertilization rate and pregnancy rate. The age of the women ranged from 27 to 37 years (mean: 33.7). In all patients, risk factors for OHSS were not observed during ovarian stimulation. All treatment cycles produced developing embryos, and there were no cycles cancelled. In all cases, cetrotide and hCG administration began on day 6 of ovarian stimulation, so that the total dose of recombinant FSH administered was 750 IU for each patient. Low-dose hCG was administered for 3 days in 6 women (total dose of hCG: 600 IU, 8 days of stimulation) and for 4 days in 1 woman (total dose of hCG: 800 IU, 9 days of stimulation). Number of mature oocytes (MII) retrieved ranged from 7 to 16 (mean: 11). Estradiol concentrations on the day of hCG administration to trigger oocyte maturation ranged from 2200.5 to 3531.2 pg/mL (mean: 2984.1 pg/mL). Overall fertilization rate was 78,6%. Clinical pregnancy was observed in 2 patients (pregnancy rate: 28.5%). All of these pregnancies are ongoing. Our preliminary results suggest that an ovarian stimulation protocol with low-dose hCG to produce inversion ratio of FSH/LH activity in the mid-follicular phase, associated to a GnRH antagonist, may be an efficient, non-expensive and safe option for women at risk of developing OHSS. The reduction in the development of small follicles induced by this protocol of ovarian stimulation, may play an important role in the prevention of the syndrome. To our knowledge, this is the first report using the inversion ratio of gonadotropins activity and a GnRH antagonist to diminish the likelihood of OHSS in high-risk patients. Nevertheless, comparative and randomized clinical trials are needed to confirm our preliminary observations.

Stimulation Length, Number of High-Sized Follicles and Estradiol on the hCG Injection Day Are Multiple Pregnancy Risk Factors in IUI

Stimulation Length, Number of High-Sized Follicles and Estradiol on the hCG Injection Day Are Multiple Pregnancy Risk Factors in IUI

Predictivity of uterine artery, arcuate artery, and intraovarian artery Doppler indices measured on the day of human chorionic gonadotropin injection on pregnancy outcomes

The uterine, arcuate, and intraovarian blood flow measurements by transvaginal color doppler ultrasonography on the day of hCG injection in 46 women undergoing treatment by IVF at Aegean University Family Planning and Infertility Research and Treatment Center were evaluated. In the pregnant group, average uterine and arcuate arteries blood flow resistance values were lower than those in nonpregnant women.