Human Chorionic Gonadotrophin Priming Research Articles

In vitro maturation of oocytes for preserving fertility in autoimmune premature ovarian insufficiency

To test whether invitro maturation (IVM) of oocytes is an option for preserving the fertility of women diagnosed with premature ovarian insufficiency (POI). Case report. University hospital. A 36-year-old amenorrheic patient was referred for fertility preservation (FP) counseling with a diagnosis of autoimmune POI. Serum follicle-stimulating hormone (21.0 and 36.3 mIU/mL) and luteinizing hormone (35.0 and 60.0 mIU/mL) levels taken 4 weeks apart were around the menopausal range. Although serum antimüllerian hormone level was low (0.76 and 0.65 ng/mL), total counts of antral follicles remained unexpectedly normal (24 and 22). Significant levels of serum antiperoxidase, anti-21-hydroxylase, and antiovary antibodies led to the diagnosis of autoimmune polyendocrinopathy. Due to the unknown time before follicular exhaustion, we undertook a FP program. After unsuccessful follicular growth following a trial of ovarian stimulation using recombinant follicle-stimulating hormone (300 IU/day for 10 days), we decided to try IVM of immature oocytes aspirated from the remaining antral-stage follicles. Obtention of immature oocyte capable of maturing invitro in a context of acute ovarian dysfunction. Two cycles of IVM were performed, leading, after human chorionic gonadotropin priming, to six and 10 cumulus-oocyte complexes recovered and four and eight metaphase II oocytes. Finally, after intracytoplasmic sperm injection, a total of eight cleavage-stage embryos were frozen. When the patient presented in the clinic 1 year later for reutilization of the cryopreserved embryos, thyroid and adrenal functions were controlled with levothyroxine and hydrocortisone. Endometrium was primed with 17ß-estradiol (2 mg/day, vaginally) for 14 days. Progesterone (600 mg/day, vaginally) was subsequently combined with E2. Two embryos were thawed and further transferred into the uterus. The patient became pregnant and uneventfully delivered two baby boys at term. We report the first pregnancy and live birth achieved using IVM for FP in a woman diagnosed with autoimmune POI. The confirmation of our results would lead to modification in the management of young women diagnosed with autoimmune POI, who are usually not considered candidates for FP and often referred for egg donation when seeking pregnancy.

Effect of Interval between Human Chorionic Gonadotropin Priming and Ovum Pick-up on the Euploid Probabilities of Blastocyst.

This retrospective study attempts to elucidate the relevance of the interval between human chorionic gonadotropin priming and oocyte pick-up (hCG-OPU) to the euploidy probability of biopsied blastocysts in preimplantation genetic tests for aneuploidy (PGT-A) cycles. A total of 1889 blastocysts from 511 patients undergoing PGT- A cycles were used. An analysis of generalized estimating equations (GEE) was used to identify whether the hCG–OPU interval is associated with euploidy probabilities of blastocysts. Accordingly, maternal age (OR: 0.925, 95% CI: 0.903–0.948, p < 0.001) and the hCG–OPU interval (OR: 1.138, 95% CI: 1.028–1.260, p = 0.013) were the two significant factors associated with the euploidy probabilities. The Cochran-Armitage trend test demonstrated that the blastocyst euploidy percentage increased progressively with the increasing hCG-OPU interval in normal responders (p = 0.006) and advanced maternal age (age ≥38 years; p = 0.020) groups. In normal responders, the euploidy rate was highest in the 38–39 h interval (43.1%, 47/109). In contrast, the euploidy rate was lowest in the 34–35 h interval (28.7%, 29/105). In conclusion, the present study demonstrated that at an hCG-OPU interval between 34–39 h, the longer the hCG-OPU interval, the higher the probability of euploidy for blastocysts.

Human Chorionic Gonadotropin Priming Does Not Improve Pregnancy Outcomes of PCOS-IVM Cycles

Background: Influence of pre-retrieval human chorionic gonadotropin (HCG) priming on outcomes of in vitro maturation (IVM) remains controversial. This study aimed to evaluate the effect of HCG priming before oocyte retrieval on clinical outcomes of IVM cycles in patients with polycystic ovarian syndrome (PCOS).Methods: This was a retrospective cohort study analyzing data from the first IVM cycles of unstimulated PCOS patients in a reproductive center of university affiliated hospital from January 2006 to December 2017. Patients received HCG injection before oocyte retrieval were assigned to HCG priming group and those without HCG administration were categorized as none HCG priming (Non-HCG) group. Main outcomes included oocyte maturation rate, number of embryos available, clinical pregnancy rate, and live birth rate. Candidate factors of clinical pregnancy rate was explored by univariate analysis and multivariate logistic regression analysis.Results: There were 324 patients meeting the inclusion and exclusion criteria. Among them, 129 women received HCG priming and 195 other did not. Women in HCG group had significantly lower basal FSH level (5.17 ± 1.63 vs. 5.80 ± 2.38) than Non-HCG group. Both FSH levels were <10 IU/L and the absolute difference was 0.63 IU/L. Other basic characteristics were similar between groups with or without HCG priming. Oocyte maturation rate was trend to be higher in HCG group (52.68 vs. 48.56%) but no statistical significance was found (P = 0.097). No significant difference in clinical pregnancy rate was found between HCG and Non-HCG groups (31.37 vs. 35.67%). Miscarriage rates (31.25 vs. 34.43%) and live birth rates were also similar between groups. HCG priming was not correlated with clinical pregnancy rate in both univariate analysis (P = 0.468) and multivariate logistic regression analysis (P = 0.538; OR = 1.212; 95%CI: 0.657–2.237).Conclusion: HCG priming before oocyte retrieval may not improve clinical outcomes of IVM in patients with PCOS.

Live birth rate after human chorionic gonadotropin priming in vitro maturation in women with polycystic ovary syndrome

BackgroundIn vitro maturation (IVM) has some advantages over conventional in vitro fertilization (IVF), particularly in polycystic ovary syndrome (PCOS) where the risk of ovarian hyperstimulation is high. We studied the live birth rate in a large series of PCOS women undergoing human chorionic gonadotropin (hCG)-priming IVM.MethodsThis retrospective study included women with PCOS aged 18–42 years undergoing IVM with hCG priming. We reported live birth rate after the first embryo transfer and cumulative live birth rate from embryos obtained in the IVM cycle. We also performed logistic regression to assess which factors predicted number of oocytes and live birth.ResultsWe included 921 women (age 28.9±3.5 years, body mass index 21.8±3.1 kg/m2, infertility duration 3.7±2.6 years, 81% primary infertility, 88% first IVF attempt, 94% ovulation induction failure). Live birth rate after the first embryo transfer was 31.7%, with a cumulative live birth rate from the cycle of 33.7%. High anti-Müllerian hormone levels predicted a high number of oocytes and a high oocyte maturation rate while the opposite was the case when luteinizing hormone levels were high.ConclusionsIn women with PCOS, hCG priming IVM was feasible and resulted in acceptable live birth rates.

Weekend-free scheduled IVF/ICSI procedures and single embryo transfer do not reduce live-birth rates in a general infertile population.

IntroductionScheduling of ovum pickup only on weekdays may result in cases of apparently suboptimal timing for human chorionic gonadotropin and ovum pickup. This study aimed to assess whether live‐birth rates were reduced in women with a potentially suboptimal day for human chorionic gonadotropin and ovum pickup to avoid weekend work, according to ultrasonographic data on the day of human chorionic gonadotropin planning.Material and methodsAn evaluation of the optimal human chorionic gonadotropin priming date was performed in treatment protocols of 1000 consecutive patients undergoing their first in vitro fertilization/intracytoplasmatic sperm injection with single‐embryo transfer. An ideal ovum pickup day was characterized by human chorionic gonadotropin‐scheduling when three or more follicles reached 17 mm (day 0) or with one day of delay (day +1) (n = 760). A non‐ideal ovum pickup was either early (day −1, −2, −3) (n = 24) or delayed (day +2, +3, +4) (n = 216). Live‐birth rates in the ideal and non‐ideal ovum pickup groups was set as primary outcome measure.ResultsEarly‐ovum pickups were excluded as they were infrequent. No differences between ideal and delayed ovum pickup groups were found regarding number of oocytes retrieved (9.87 vs. 9.78, p = 0.990), pregnancy rates (28.3% vs. 29.6%, p = 0.701) or live‐birth rates (26.2% vs. 25.9%, p = 0.939). However, sub analyses indicated that treatment with gonadotropin releasing hormone antagonists resulted in significantly lower clinical pregnancy rates in delayed ovum pickups (odds ratio 0.46, p = 0.014), compared with agonist treatments.ConclusionsWeekend work may not be needed for in vitro fertilization/intracytoplasmatic sperm injection single‐embryo transfer treatments. However, in gonadotropin releasing hormone antagonist cycles, delaying ovum pickup more than one day may result in unfavorable outcomes.

Human chorionic gonadotrophin priming for fertility treatment with in vitro maturation.

In vitro maturation (IVM) is a fertility treatment that involves the transvaginal retrieval of immature oocytes, and their subsequent maturation and fertilisation. Although the live birth rate is lower than conventional in vitro fertilisation (IVF) with ovarian stimulation, it is a useful treatment, as it avoids the risk of ovarian hyperstimulation syndrome (OHSS). Women with polycystic ovaries (PCO) or polycystic ovarian syndrome (PCOS) are at an increased risk of OHSS. Thus, IVM may be a more useful treatment in this patient group.Strategies to maximise the maturation rates of the immature oocytes are important. This review focuses on the administration of human chorionic gonadotrophin (hCG) prior to immature oocyte retrieval. To determine the effectiveness and safety of hCG priming in subfertile women who are undergoing IVM treatment in the context of assisted reproduction. We searched the following electronic databases up to 29 August 2016: Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries ClinicalTrials.gov and WHO ICTPR to identify ongoing and registered trials. We sought recently published papers not yet indexed in the major databases, and reviewed the reference lists of reviews and retrieved studies as sources of potentially relevant studies. There were no language restrictions. We included randomised controlled trials (RCTs) that compared hCG priming with placebo or no priming in women undergoing IVM. We also included RCTs that compared different doses of hCG, or the timing of oocyte retrieval. The primary outcomes were live birth rate and miscarriage rate per woman randomised. Two review authors independently selected studies for inclusion, and with a third author, assessed risk of bias and extracted data. We contacted the original authors where data were missing. For dichotomous outcomes, we used the Mantel-Haenszel method to calculate odds ratios (OR). For continuous outcomes, we calculated the mean differences (MD) between treatment groups. We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of the evidence using GRADE methods. We included four studies, with a total of 522 women, in the review. One of these studies did not report outcomes per woman randomised, and so was not included in formal analysis. Three studies investigated 10,000 units hCG priming compared to no priming. One study investigated 20,000 units hCG compared to 10,000 units hCG priming. Three studies only included women with PCOS (N = 122), while this was an exclusion criteria in the fourth study (N = 400).We rated all four studies as having an unclear risk of bias in more than one of the seven domains assessed. The quality of the evidence was low, the main limitations being lack of blinding and imprecision.When 10,000 units hCG priming was compared to no priming, we found no evidence of a difference in the live birth rates per woman randomised (OR 0.65, 95% confidence intervals (CI) 0.24 to 1.74; one RCT; N = 82; low quality evidence); miscarriage rate (OR 0.60, 95% CI 0.21 to 1.72; two RCTs; N = 282; I² statistic = 21%; low quality evidence), or clinical pregnancy rate (OR 0.52, 95% CI 0.26 to 1.03; two RCTs, N = 282, I² statistic = 0%, low quality evidence). Though inconclusive, our findings suggested that hCG may be associated with a reduction in clinical pregnancy rates; 22% of women who received no priming achieved pregnancy, while between 7% and 23% of women who received hCG priming did so.The study comparing 20,000 units hCG with 10,000 units hCG did not report sufficient data to enable us to calculate odds ratios.No studies reported on adverse events (other than miscarriage) or drug reactions. This review found no conclusive evidence that hCG priming had an effect on live birth, pregnancy, or miscarriage rates in IVM. There was low quality evidence that suggested that hCG priming may reduce clinical pregnancy rates, however, these findings were limited by the small number of data included. As no data were available on adverse events (other than miscarriage) or on drug reactions, we could not adequately assess the safety of hCG priming. We need further evidence from well-designed RCTs before we can come to definitive conclusions about the role of hCG priming, and the optimal dose and timing.

MiR-125b regulates endometrial receptivity by targeting MMP26 in women undergoing IVF-ET with elevated progesterone on HCG priming day.

On the women undergoing IVF-ET with elevated progesterone on human chorionic gonadotrophin priming, the assisted reproductive technology outcome is poor. But, due to the unknown mechanism of this process, no effective method has been found to overcome this difficulty. Here, we investigated the roles of miR-125b and its target gene, MMP26, in endometrial receptivity (ER) in these women. The expression of miR-125b was significantly up-regulated in EECs in women with elevated progesterone during the window of implantation, and it showed a progesterone-dependent effect in vitro. Similarly, the expression of miR-125b was significantly up-regulated in the preimplantation period, and was down-regulated in the implantation period and the post-implantation period in mouse EECs. In addition, miR-125b showed a greater decrease at implantation sites than it did at interimplantation sites. The luciferase report assay demonstrated that MMP26 is a target gene of miR-125b. And the expression profile of MMP26 showed an inverse relationship with miR-125b in vivo and in vitro. Overexpression of miR-125b in human EECs inhibited cell migration and invasion. Gain-of-function of miR-125b induced a significant decrease in the number of implantation sites. In conclusion, these data shed new light on how miR-125b triggers ER decline through the regulation of MMP26 function.

Does supplementation of in-vitro culture medium with melatonin improve IVF outcome in PCOS?

Human pre-ovulatory follicular fluid (FF) contains a higher concentration of melatonin than serum. The aim of this study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcomes of an in-vitro maturation (IVM) IVF-embryo transfer programme for patients with polycystic ovarian syndrome (PCOS). Melatonin concentrations in the culture media of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the clinical outcomes after using IVM media with or without melatonin were analysed. In the culture media of GC or COC, melatonin concentrations gradually increased. When human chorionic gonadotrophin priming protocols were used, implantation rates in the melatonin-supplemented group were higher than those of the non-supplemented control group (P<0.05). Pregnancy rates were also higher, although not significantly. The findings suggest that the addition of melatonin to IVM media may improve the cytoplasmic maturation of human immature oocytes and subsequent clinical outcomes. It is speculated that follicular melatonin may be released from luteinizing GC during late folliculogenesis and that melatonin supplementation may be used to improve the clinical outcomes of IVM IVF-embryo transfer.Melatonin is primarily produced by the pineal gland and regulates a variety of important central and peripheral actions related to circadian rhythms and reproduction. Interestingly, human pre-ovulatory follicular fluid contains a higher concentration of melatonin than serum. However, in contrast to animal studies, the direct role of melatonin on oocyte maturation in the human system has not yet been investigated. So, the aim of the study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcome of an in-vitro maturation (IVM) IVF-embryo transfer programme for PCOS patients. The melatonin concentrations in culture medium of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the clinical outcomes of IVM IVF-embryo transfer using IVM medium alone or supplemented with melatonin were analysed. In the culture media of GC or COC, the melatonin concentration gradually increased. With human chorionic gonadotrophin priming, the pregnancy and implantation rates in the melatonin-supplemented group were higher than those of the non-supplemented control (P<0.05). Our findings suggest that follicular melatonin is released from luteinizing GC during late folliculogenesis and plays a positive role in oocyte maturation. Therefore, addition of melatonin into IVM medium may improve cytoplasmic maturation of human immature oocytes and subsequent clinical outcomes.

Quantification of oocyte-specific transcripts in follicle-enclosed oocytes during antral development and maturation in vitro

Oocyte cytoplasmic maturation is influenced by the quantity of synthesized RNA and proteins accumulated and stored during growth. Transcriptional repression and degradation of transcripts occur during oocyte nuclear maturation, and prolonged transcriptional arrest might compromise RNA stores for early development. RNA quantification of key genes in oocytes might be valuable when setting up in vitro cultures that lack the normal hormonal interplay found in vivo. This study quantifies gene expression levels in relation to follicle culture time and time of oocyte maturation in a mouse model. RNA levels of Gdf-9, Bmp-15, Mater, Zar-1, Npm-2 and Fgf-8 were measured in germinal vesicle oocytes along fixed times during in vitro follicle development. For all genes, the highest mRNA levels were detected in oocytes in the pre-antral follicle stage. Antrum formation was associated with a progressive shutdown in transcription leading to mRNA values lower than those in vivo preovulatory oocytes by extending period of in vitro culture. In contrast to in vitro-matured oocytes, the in vivo oocytes from 22- and 29-day-old prepubertal animals obtained after pregnant mare's serum gonadotrophin and human chorionic gonadotrophin priming did not down-regulate transcripts upon maturation stimulus except for Mater. These findings show that oocyte gene expression patterns under in vitro conditions can, at certain times, mimic what is reported to occur under in vivo conditions. Moreover, they also show that meiotically competent oocytes kept in a prolonged transcriptionally inactive stage express altered levels of key transcripts compared with in vivo in both immature and mature oocytes.

Effect of different gonadotrophin priming on IVM of oocytes from women with normal ovaries: a prospective randomized study

This study was designed to determine if the efficiency of in-vitro maturation (IVM) in women with normal ovaries can be improved by gonadotrophin administration. 400 women were randomly allocated in four groups: group A, non-primed cycles; group B, human chorionic gonadotrophin (HCG)-primed cycles; group C, FSH-primed cycles; and group D, FSH- plus HCG-primed cycles. There were significant differences in the IVM rate among the groups. In groups where HCG was used, the overall maturation rate was higher (57.9% in group B and 77.4% in group D; 48.4% in group A and 50.8% in group C) and the percentage of total available metaphase II-stage oocytes was higher (60.4% in group B and 82.1% in group D; 48.4% in group A and 50.8% in group C). The overall clinical pregnancy rate per transfer (CPR) was 18.3% and the implantation rate (IR) was 10.6%. There was a difference in CPR among the groups: group D (29.9%) versus group A (15.3%), P = 0.023; group D versus group B (7.6%), P < 0.0001; group D versus group C (17.3%), P = 0.046. The results of this study are clearly in favour of FSH plus HCG priming. FSH priming and HCG priming alone showed no significant effects on clinical outcome.

Extended 35 to 38 hours after HCG priming for immature oocyte retrieval increases oocyte maturation rate in IVM treatment

To evaluate whether extending the interval from HCG priming to immature oocyte retrieval increase oocytes maturation rate following in vitro maturation (IVM). Retrospective analysis comparing of oocyte maturation rate in immature oocytes retrieved 35 h (group 1) and 38 h (group 2) after HCG priming. 100 patients with polycystic ovary syndrome (PCOS) for IVM treatment were included in this study. Oocyte retrieval was performed between day 9 to day 16 of the menstrual cycle based on the patient's cycle length. When the endometrium thickness reached to ≥6 mm, 10,000 IU human chorionic gonadotropin (HCG) was given. Between January 1, 2006 to February 9, 2006, immature oocyte collection was performed after 35h HCG priming (group 1; n = 87) and between February 13, 2007 to April 21, 2007, immature oocyte retrieval was performed 38 h after HCG priming (group 2; n = 17). Following oocyte retrieval, the maturity of oocytes was assessed and the mature oocytes were subjected insemination by intracytoplasmic sperm injection (ICSI) 3 hours after collection. The remaining immature oocytes were cultured in IVM-medium (Coopersurgical/SAGE) supplemented with 75 mIU/mL FSH and LH up to 48 h. Fertilized zygotes were cultured in Embryo Maintenance Medium (Coopersurgical/SAGE), and the resulted embryos were transferred. There was no difference in the mean number of oocytes retrieved (16.3 ± 9.2 vs. 15.2 ± 9.1) between two groups. However, on the day of oocyte retrieval, the rate of matured oocytes collected was significantly higher (P< 0.01). in group 2 (15.1%, 39/258) compared to group 1 (8.3%, 118/1416). In addition, oocyte maturation rate after 24 h IVM was significantly higher (P< 0.01) in group 2 (54.3%, 119/219) compared to group 1 (36.4% 338/1298). The total maturation rate after 48h IVM was significantly higher (P< 0.05) in group 2 (72.1%, 186/258) compared to group 1 (65.5%, 928/1416). Although fertilization and the cleavage rates were comparable between two groups, the clinical pregnancy rate seems higher in group 2 compared to group 1. The results suggest that extending the HCG priming time from 35 hours to38 hours for immature oocyte retrieval promotes more oocyte maturation in vivo and obtains higher in vitro maturation rate of immature oocytes. Therefore, immature oocyte retrieval following 38 hours of HCG priming may improve subsequent pregnancy outcome of IVM treatment.

P-704: Comparison of embryology and clinical outcome between IVM cycles with and without mature oocytes collected following HCG priming

It has been known that mature oocytes (metaphase-II stage) can be retrieved from relatively small follicles after human chorionic gonadotropin (HCG) priming from infertile women with polycystic ovaries (PCO). However, there is no report to compare the clinical outcome between in vitro maturation (IVM) treatment cycles with mature oocytes and without mature oocytes collected. Retrospective analysis between treatment cycles with (group 1) and without (group 2) MII-stage oocytes collected. IVM was performed in 58 PCO patients (60 cycles) from June 2005 to March 2006. Egg collection was performed between day-9 and -16 of menstrual cycle based on the patient’s cycle length and endometrium thickness (> 6 mm). The patients were administrated 10,000 IU of HCG subcutaneously 36 h prior to egg collection. The largest follicle size and endometrium thickness were measured right before egg collection. After collection, the oocyte maturity was assessed under the dissecting microscope with high magnification using sliding method. The mature oocytes were inseminated by intracytoplasmic sperm injection (ICSI) and the remaining immature oocytes were cultured for IVM until 48 h in IVM medium (Coopersurgical/SAGE Company) supplemented with 75 mIU/ml FSH and LH. Fertilized zygotes were cultured in Embryo Maintenance Medium (Coopersurgical/SAGE Company). The correlation of the follicular size with the mature oocytes collected was analyzed. In addition, oocyte IVM, fertilization, and cleavage as well as pregnancy rates between two groups were analyzed. At egg collection, total 15% (91/629) of oocytes collected were MII stage in group 1. The MII-stage oocytes were obtained from the follicles sized 10-14 mm diameter. Morphology of cumulus-oocyte complex (COC) with MII-stage oocytes was different between the size of follicles < 12 mm and ≥ 12 mm follicles. There were no difference in the mean number of oocytes collected (20.9 vs. 19.3) and IVM rates (67.8% vs. 62.7%) between groups. Although the fertilization rate in group 2 (86.8 %) was higher than that of group 1 (71.3 %), the cleavage rate were comparable between two groups. The clinical pregnancy rate was significantly higher (P < 0.05) in group 1 (40%, 12/30) than that of group 2 (23.3%, 7/30). These results imply that mature oocytes can be retrieved from the follicle sized small as 10 mm in diameter following HCG priming in infertile women with PCO. It seems that there is correlation between COC morphology and oocyte maturity and quality.

Effect of gonadotrophin priming on in-vitro maturation of oocytes collected from women at risk of OHSS

This study examined the effects of human menopausal gonadotrophin (HMG) or human chorionic gonadotrophin (HCG) priming on cumulus–oocyte complex (COC) morphology, oocyte maturation and embryo development in patients undergoing in-vitro maturation (IVM) cycles. The patients were primed with nothing (group 1), low-dose HMG (group 2) or 10,000 IU HCG (group 3) before oocyte retrieval. COC with dispersed cumulus cell appearance was only observed in group 3. In addition, 11% of metaphase II stage oocytes at the time of retrieval were collected from group 3. Oocyte maturation in vitro in group 3 was faster than that in groups 1 and 2. The blastocyst development rate of residual embryos after embryo transfer in group 3 was significantly higher than that of groups 1 and 2 ( P < 0.05). These results suggest that HCG priming may stimulate the COC, promote oocyte maturation, and improve developmental competence in IVM cycles.

Ultrasonographic assessment of endometrial receptivity at embryo transfer in an in vitro maturation of oocyte program

Ultrasonographic assessment of endometrial receptivity at embryo transfer in an in vitro maturation of oocyte program

Immature oocyte retrieval and in vitro maturation in women with polycystic ovaries at 36 h or 40 h after the administration of HCG.

Objective: Priming with human chorionic gonadotropin (HCG) 36 h before immature oocyte retrieval increases the oocyte maturation rate, therefore, potentially improves pregnancy rate. However, it is unclear whether the oocyte quality is affected by HCG priming 40 h before immature oocyte retrieval. The purpose of the present study was to compare oocyte and embryo quality following 36 h or 40 h priming with HCG before immature oocyte retrieval.

Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome

The present study examined whether the rates of oocyte maturation, fertilization and development, as well as pregnancy rate could be improved by human chorionic gonadotrophin (HCG) priming 36 h before immature oocyte retrieval in patients with polycystic ovarian syndrome (PCOS). Immature oocyte retrieval was performed on day 10-14 of the cycles and patients were randomly allocated either to be primed with 10 000 IU of HCG before the retrieval, or not primed. Immature oocytes were cultured for 24-48 h in TC-199 medium with 20% (v/v) inactivated fetal bovine serum (FBS) supplemented with 75 mIU/ml follicle stimulating hormone (FSH) and luteinizing hormone (LH). Intracytoplasmic sperm injection (ICSI) was performed in all mature oocytes and the resulting embryos were transferred on day 2 or 3 after ICSI. A total of 17 patients underwent 24 completed treatment cycles. Thirteen cycles were primed with HCG and 11 other cycles were not primed. The mean number of oocytes retrieved was comparable in the two groups (7.8 +/- 3.9 versus 7.4 +/- 5.2). The percentage of oocytes achieving maturation at 48 h was significantly higher (P < 0.05) in the HCG-primed group (84.3%, 86/102) than in the non-HCG-primed group (69.1%, 56/81). Oocyte maturation was hastened in the HCG-primed group. Following 24 h of culture, 78.2 +/- 7.1% of oocytes were matured in the HCG-primed group compared with 4.9 +/- 2.5% of oocytes in the non-HCG-primed group (P < 0.001). There were no significant differences in the rates of oocyte fertilization and cleavage in these two groups. There were five clinical pregnancies (38.5%) in the HCG-primed group, and three pregnancies (27.3%) in the non-HCG-primed group.

Enhancement of gonadotrophin induced 17,20-lyase suppression one week after human chorionic gonadotrophin priming.

A single injection of 1500 IU of human chorionic gonadotrophin (hCG) in normal men, induced a block in the conversion of 17-hydroxyprogesterone (17-OHP) to testosterone (T) which reached its maximum 24 h after hCG loading. One week after hCG administration both basal 17-OHP (3.8 +/- 0.6 vs 5.1 +/- 0.5 nmol/l, P less than 0.02) and T levels (15.1 +/- 1.7 vs 18.5 +/- 2.3 nmol/l, P less than 0.05) were about 20% lower than before hCG exposure. The ratio 17-OHP to T (0.29 +/- 0.04 vs 0.31 +/- 0.04, P greater than 0.10) was however similar, suggesting recovery from the prior 17,20-lyase suppression at a lower overall capacity of T synthesis. hCG administration one week after the priming dose elicited an increase in the ratio 17-OHP to T, which was about twice as high as after the first hCG injection. Together the data suggest: 1) suppression of testicular steroidogenesis proximal to 17-OHP one week after hCG priming, 2) enhanced hCG induced 17,20-lyase suppression one week after hCG exposure.