Skip to main content

Advertisement

SpringerLink
Log in

The effect of intrauterine human chorionic gonadotropin flushing on live birth rate after vitrified-warmed embryo transfer in programmed cycles: a randomized clinical trial

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the influence of intrauterine human chorionic gonadotropin (hCG) before embryo transfer on the clinical pregnancy and live birth rates after vitrified-warmed embryo transfer (ET) in programmed cycles.

Methods

This study was a single-blind randomized clinical trial for eligible patients underwent frozen ET cycles with long-term hormonal GnRH agonist protocol for endometrial preparation. Immediately prior to ET, the women were randomly divided into three groups. In the experimental group, 7–10 min before embryo transfer, 500 IU of hCG with a 40 μL of culture medium was injected into the uterus. In the first control (sham) group, 7–10 min before ET just 40 μL of culture medium intrauterine was infused. In the second control group, no intervention was done. The pregnancy outcomes were compared in the three groups using appropriate statistical tests.

Results

Finally, 180 patients allocated into three groups. There was no significant difference in terms of patients ‘characteristics among three groups. No significant difference was found in terms of clinical pregnancy among three groups. The miscarriage rate in control group (0%) was significantly lower than those of in the sham and hCG groups (9.8% and P = 0.01, 6.6% and P = 0.04, respectively). In addition, live birth rate (39.3%) in control group was significantly higher than those of in the sham and hCG groups (16.4% and P = 0.005, 23% and P = 0.051, respectively).

Conclusion(s)

It was found that intrauterine injection of 500 IU hCG before vitrified-warmed ET at cleavage stage has no beneficial effect on pregnancy outcome and is not suggested. NCT02355925.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hong KH, Forman EJ, Werner MD et al (2014) Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, placebo-controlled trial. Fertil Steril 102(6):1591–1595 e2

    Article  CAS  PubMed  Google Scholar 

  2. Aaleyasin A, Aghahosseini M, Rashidi M et al (2014) In vitro fertilization outcome following embryo transfer with or without preinstillation of human chorionic gonadotropin into the uterine cavity: a randomized controlled trial. Gynecol Obstet Invest 79(3):201–205

    Article  PubMed  Google Scholar 

  3. Makrigiannakis A, Minas V, Kalantaridou SN, Nikas G, Chrousos GP (2006) Hormonal and cytokine regulation of early implantation. Trends Endocrinol Metab 17(5):178–185 (Epub 2006/05/16)

    Article  CAS  PubMed  Google Scholar 

  4. Licht P, Lösch A, Dittrich R, Neuwinger J, Siebzehnrübl E, Wildt L (1998) Novel insights into human endometrial paracrinology and embryo-maternal communication by intrauterine microdialysis. Hum Reprod Update 4(5):532–538

    Article  CAS  PubMed  Google Scholar 

  5. Edwards RG (2007) Chorionic gonadotrophin, genes and embryonic signals regulating the implantation window. Reprod Biomed Online 14(4):538–540 (Epub 2007/04/12)

    Article  CAS  PubMed  Google Scholar 

  6. Bonduelle ML, Dodd R, Liebaers I, Van Steirteghem A, Williamson R, Akhurst R (1988) Chorionic gonadotrophin-beta mRNA, a trophoblast marker, is expressed in human 8-cell embryos derived from tripronucleate zygotes. Hum Reprod 3(7):909–914 (Epub 1988/10/01)

    Article  CAS  PubMed  Google Scholar 

  7. Sherwin JR, Sharkey AM, Cameo P et al (2007) Identification of novel genes regulated by chorionic gonadotropin in baboon endometrium during the window of implantation. Endocrinology 148(2):618–626 (Epub 2006/11/18)

    Article  CAS  PubMed  Google Scholar 

  8. Banerjee P, Fazleabas AT (2010) Endometrial responses to embryonic signals in the primate. Int J Dev Biol 54(2–3):295–302 (Epub 2009/10/31)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mansour R, Tawab N, Kamal O et al (2011) Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection: a prospective randomized study. Fertil Steril 96(6):1370–1374 e1 (Epub 2011/11/04)

    Article  CAS  PubMed  Google Scholar 

  10. Santibanez A, Garcia J, Pashkova O et al (2014) Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical pregnancy rates from in vitro fertilisation cycles: a prospective study. Reprod Biol Endocrinol 12:9 (Epub 2014/01/31)

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wirleitner B, Schuff M, Vanderzwalmen P et al (2015) Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study. Reprod Biol Endocrinol 13(1):70

    Article  PubMed  PubMed Central  Google Scholar 

  12. Craciunas L, Tsampras N, Coomarasamy A, Raine-Fenning N (2016) Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction. Cochrane Database Syst Rev 5:CD011537 (Epub 2016/05/20)

    Google Scholar 

  13. Osman A, Pundir J, Elsherbini M, Dave S, El-Toukhy T, Khalaf Y (2016) The effect of intrauterine HCG injection on IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online 33(3):350–359

    Article  CAS  PubMed  Google Scholar 

  14. Firouzabadi RD, Janati S, Razi MH (2016) The effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: a randomized clinical trial. Int J Reprod BioMed 14(10):657

    Article  Google Scholar 

  15. Riboldi M, Barros B, Piccolomini M, Alegretti J, Motta E, Serafini P (2013) Does the intrauterine administration of rhCG before vitrified blastocysts transfer improves the potential of pregnancies when using blastocysts of inferior morphological grading? Fertil Steril 100(3):S289

    Article  Google Scholar 

  16. Madani T, Ghaffari F, Kiani K, Hosseini F (2009) Hysteroscopic polypectomy without cycle cancellation in IVF cycles. Reprod Biomed Online 18(3):412–415 (Epub 2009/03/21)

    Article  PubMed  Google Scholar 

  17. Ghaffari F, Arabipoor A, Bagheri Lankarani N, Hosseini F, Bahmanabadi A (2016) Hysteroscopic polypectomy without cycle cancellation in IVF/ICSI cycles: a cross-sectional study. Eur J Obstet Gynecol Reprod Biol 205:37–42 (Epub 2016/08/28)

    Article  PubMed  Google Scholar 

  18. Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Hassani F, Movaghar B (2009) Vitrification versus slow freezing gives excellent survival, post warming embryo morphology and pregnancy outcomes for human cleaved embryos. J Assist Reprod Genet 26(6):347–354 (Epub 2009/06/11)

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zegers-Hochschild F, Adamson GD, de Mouzon J et al (2009) The international committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 24(11):2683–2687

    Article  CAS  PubMed  Google Scholar 

  20. Janati S, Dehghani Firouzabadi R, Mohseni F, Razi M (2014) Evaluation the effect of intrauterine human chorionic gonadotropin injection before embryo transfer in implantation and pregnancy rate in infertile patients and comparison with conventional embryo transfer in IVF/ICSI/embryo transfer cycles: a randomized clinical trial. Int J Fertil Steril 8(Suppl 1):203

    Google Scholar 

  21. Zarei A, Parsanezhad ME, Younesi M et al (2014) Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/intracytoplasmic sperm injection: a randomized clinical trial. Iran J Reprod Med 12(1):1–6 (Epub 2014/05/07)

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Strug MR, Su R, Young JE et al (2016) Intrauterine human chorionic gonadotropin infusion in oocyte donors promotes endometrial synchrony and induction of early decidual markers for stromal survival: a randomized clinical trial. Hum Reprod 31(7):1552–1561 (Epub 2016/04/29)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank all the participants and co-workers in Royan Institute for their assistance in this study.

Funding

No financial support has been granted.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, P.O. Box 16656-59911, Tehran, Iran

    Maryam Hafezi, Tahereh Madani, Arezoo Arabipoor, Zahra Zolfaghari, Marya Sadeghi & Fariba Ramezanali

Authors
  1. Maryam Hafezi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tahereh Madani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arezoo Arabipoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zahra Zolfaghari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marya Sadeghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fariba Ramezanali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MH: project conceptualization, methodology, administration, and manuscript writing/editing. TM: project conceptualization, methodology and supervision, and manuscript writing/editing. AA: data interpretation and manuscript writing/editing. ZZ: data analysis and manuscript editing. MS: data collection and follow-up and manuscript editing. FR: project administration, investigation, methodology, and manuscript editing.

Corresponding author

Correspondence to Fariba Ramezanali.

Ethics declarations

Conflict of interest

Author Maryam Hafezi declares that she has no conflict of interest. Author Tahereh Madani declares that she has no conflict of interest. Author Arezoo Arabipoor declares that she has no conflict of interest. Author Zahra Zolfaghari declares that she has no conflict of interest. Author Marya Sadeghi declares that she has no conflict of interest. Author Fariba Ramezanali declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards ethical standards committee of Royan Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval code (EC/93/1069).

Informed consent

Informed written consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hafezi, M., Madani, T., Arabipoor, A. et al. The effect of intrauterine human chorionic gonadotropin flushing on live birth rate after vitrified-warmed embryo transfer in programmed cycles: a randomized clinical trial. Arch Gynecol Obstet 297, 1571–1576 (2018). https://doi.org/10.1007/s00404-018-4752-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4752-2

Keywords

Search

Navigation