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Comparing the efficacy of urinary and recombinant hCG on oocyte/follicle ratio to trigger ovulation in women undergoing intracytoplasmic sperm injection cycles: a randomized controlled trial

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

To compare the number of oocytes per follicles in ovulation induction with 10,000 IU urinary hCG (uhCG) and two different doses of recombinant hCG (rhCG) in women undergoing intracytoplasmic sperm injection (ICSI) cycles.

Methods

This study was a prospective, randomized controlled trial which was performed on 180 primary infertile women undergoing ICSI cycles. All eligible patients underwent a standard GnRH-a long protocol. When at least two follicles reached a diameter of 18 mm, all patients were randomized to receive 10,000 IU urinary hCG or 250 μg recombinant hCG or 500 μg recombinant hCG for ovulation induction. Primary outcome measure included the number of oocytes retrieved per aspirated follicles. Secondary outcome measures were the number of oocytes retrieved, the number of mature oocytes, the number and quality of generated embryos, fertilization rate, implantation rate, chemical and clinical pregnancy rates and OHSS occurrence rate.

Results

The mean number of retrieved oocytes per follicles were 71.82 ± 15.09, 69.84 ± 17.44 and 77.16 ± 17.61 in 10,000 IU uhCG, 250 μg rhCG and 500 μg rhCG, respectively which was significantly higher with 500 μg rhCG than the lower dose(P = .04). Other cycles and clinical outcomes were comparable between groups.

Conclusion

Recombinant hCG shows equivalent efficacy to urinary hCG in terms of the number of oocytes per aspirated follicles in selected patients undergoing ICSI; however, 500 μg rhCG seems to be more advantageous than the lower dose in this indication. Larger randomized trials are needed to generalize this strategy.

ClinicalTrials.gov identifier: NCT01507376.

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References

  1. Gougeon A. Regulation of ovarian follicular development in primates: facts and hypotheses. Endocr Rev. 1996;17(2):121–55.

    PubMed  CAS  Google Scholar 

  2. Pierce JG, Parsons TF. Glycoprotein hormones: structure and function. Annu Rev Biochem. 1981;50:465–95.

    Article  PubMed  CAS  Google Scholar 

  3. The International Recombinant Human Chorionic Gonadotropin Study Group. Induction of ovulation in World Health Organization group II anovulatory women undergoing follicular stimulation with recombinant human follicle-stimulating hormone: a comparison of recombinant human chorionic gonadotropin (rhCG) and urinary hCG. Fertil Steril. 2001;75(6):1111–8.

    Article  Google Scholar 

  4. Penarrubia J, Balasch J, Fabregues F, Creus M, Civico S, Vanrell JA. Recurrent empty follicle syndrome successfully treated with recombinant human chorionic gonadotrophin. Hum Reprod. 1999;14(7):1703–6.

    Article  PubMed  CAS  Google Scholar 

  5. Loumaye E, Martineau I, Piazzi A, et al. Clinical assessment of human gonadotrophins produced by recombinant DNA technology. Hum Reprod. 1996;11 Suppl 1:95–107. discussion 17-9.

    PubMed  CAS  Google Scholar 

  6. Abdelmassih V, Oliveira FG, Goncalves SP, Varella AD, Diamond MP, Abdelmassih R. A prospective, randomized and blinded comparison between 10,000 IU urinary and 250 microg recombinant human chorionic gonadotropin for oocyte maturation in in vitro fertilization cycles. J Assist Reprod Genet. 2005;22(4):149–53.

    Article  PubMed  Google Scholar 

  7. Chang P, Kenley S, Burns T, et al. Recombinant human chorionic gonadotropin (rhCG) in assisted reproductive technology: results of a clinical trial comparing two doses of rhCG (Ovidrel) to urinary hCG (Profasi) for induction of final follicular maturation in in vitro fertilization-embryo transfer. Fertil Steril. 2001;76(1):67–74.

    Article  PubMed  CAS  Google Scholar 

  8. Kovacs P, Kovats T, Bernard A, Zadori J, Szmatona G, Kaali SG. Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization. Fertil Steril. 2008;90(6):2133–7.

    Article  PubMed  CAS  Google Scholar 

  9. Trinchard-Lugan I, Khan A, Porchet HC, Munafo A. Pharmacokinetics and pharmacodynamics of recombinant human chorionic gonadotrophin in healthy male and female volunteers. Reprod Biomed Online. 2002;4(2):106–15.

    Article  PubMed  CAS  Google Scholar 

  10. Driscoll GL, Tyler JP, Hangan JT, Fisher PR, Birdsall MA, Knight DC. A prospective, randomized, controlled, double-blind, double-dummy comparison of recombinant and urinary HCG for inducing oocyte maturation and follicular luteinization in ovarian stimulation. Hum Reprod. 2000;15(6):1305–10.

    Article  PubMed  CAS  Google Scholar 

  11. Sakhel K, Khedr M, Schwark S, Ashraf M, Fakih MH, Abuzeid M. Comparison of urinary and recombinant human chorionic gonadotropin during ovulation induction in intrauterine insemination cycles: a prospective randomized clinical trial. Fertil Steril. 2007;87(6):1357–62.

    Article  PubMed  CAS  Google Scholar 

  12. The European Recombinant Human Chorionic Gonadotrophin Study Group. Induction of final follicular maturation and early luteinization in women undergoing ovulation induction for assisted reproduction treatment--recombinant HCG versus urinary HCG. The European Recombinant Human Chorionic Gonadotrophin Study Group. Hum Reprod. 2000;15(7):1446–51.

    Article  Google Scholar 

  13. Papanikolaou EG, Fatemi H, Camus M, et al. Higher birth rate after recombinant hCG triggering compared with urinary-derived hCG in single-blastocyst IVF antagonist cycles: a randomized controlled trial. Fertil Steril. 2010;94(7):2902–4.

    Article  PubMed  CAS  Google Scholar 

  14. Youssef MA, Al-Inany HG, Aboulghar M, Mansour R, Abou-Setta AM. Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles. Cochrane Database Syst Rev. 2011;(4):CD003719.

    PubMed  Google Scholar 

  15. Chan CC, Ng EH, Tang OS, Yeung WS, Lau EY, Ho PC. A prospective, randomized, double-blind study to compare two doses of recombinant human chorionic gonadotropin in inducing final oocyte maturity and the hormonal profile during the luteal phase. J Clin Endocrinol Metab. 2005;90(7):3933–8.

    Article  PubMed  CAS  Google Scholar 

  16. Littman ED, Milki AA. The combination of urinary and recombinant HCG improves outcome in patients with decreased oocyte/follicle ratio in previous cycles. Eur J Obstet Gynecol Reprod Biol. 2003;109(1):60–2.

    Article  PubMed  CAS  Google Scholar 

  17. Veeck LL. Oocyte assessment and biological performance. Ann N Y Acad Sci. 1988;541:259–74.

    Article  PubMed  CAS  Google Scholar 

  18. Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Hassani F, Movaghar B. Vitrification versus slow freezing gives excellent survival, post warming embryo morphology and pregnancy outcomes for human cleaved embryos. J Assist Reprod Genet. 2009;26(6):347–54.

    Article  PubMed  Google Scholar 

  19. Hoff JD, Quigley ME, Yen SS. Hormonal dynamics at midcycle: a reevaluation. J Clin Endocrinol Metab. 1983;57(4):792–6.

    Article  PubMed  CAS  Google Scholar 

  20. Meniru GI, Craft IL. Evidence from a salvaged treatment cycle supports an aetiology for the empty follicle syndrome that is related to terminal follicular developmental events. Hum Reprod. 1997;12(11):2385–7.

    Article  PubMed  CAS  Google Scholar 

  21. Phillips DM, Dekel N. Maturation of the rat cumulus-oocyte complex: structure and function. Mol Reprod Dev. 1991;28(3):297–306.

    Article  PubMed  CAS  Google Scholar 

  22. Ludwig M, Doody KJ, Doody KM. Use of recombinant human chorionic gonadotropin in ovulation induction. Fertil Steril. 2003;79(5):1051–9.

    Article  PubMed  Google Scholar 

  23. Zegers-Hochschild F, Fernandez E, Mackenna A, Fabres C, Altieri E, Lopez T. The empty follicle syndrome: a pharmaceutical industry syndrome. Hum Reprod. 1995;10(9):2262–5.

    PubMed  CAS  Google Scholar 

  24. Krotz S, Bhagavath B, Hackett R, Pagidas K, Carson S, Robins J. Comparison of IVF retrieval and clinical outcomes in 744 patients using recombinant versus urinary human chorionic gonadotropins to trigger ovulation. Fertil Steril. 2008;90:S224–S5.

    Article  Google Scholar 

  25. Uhler ML, Beltsos AN, Grotjan HE, Lederer KJ, Lifchez AS. Age-matched comparison of recombinant and urinary HCG for final follicular maturation. Reprod Biomed Online. 2006;13(3):315–20.

    Article  PubMed  CAS  Google Scholar 

  26. Al-Inany HG, Aboulghar M, Mansour R, Proctor M. Recombinant versus urinary human chorionic gonadotrophin for ovulation induction in assisted conception. Cochrane Database Syst Rev. 2005;(2):CD003719.

    PubMed  Google Scholar 

  27. Farrag A, Costantini A, Manna C, Grimaldi G. Recombinant HCG for triggering ovulation increases the rate of mature oocytes in women treated for ICSI. J Assist Reprod Genet. 2008;25(9–10):461–6.

    Article  PubMed  CAS  Google Scholar 

  28. Zeke J, Kanyo K, Zeke H, et al. Pregnancy rates with recombinant versus urinary human chorionic gonadotropin in in vitro fertilization: an observational study. Sci World J. 2011;11:1781–7.

    Article  CAS  Google Scholar 

  29. Clua E, Martinez F, Tur R, Sanmartin P, Chueca A, Barri PN. Triggering ovulation with 250 mug or 500 mug of r-hCG in oocyte donors treated with antagonist protocol has no effect on the number of mature oocytes retrieved: a randomized clinical trial. Gynecol Endocrinol. 2012;28(9):678–81.

    Google Scholar 

  30. Kahraman S, Karlikaya G, Kavrut M, Karagozoglu H. A prospective, randomized, controlled study to compare two doses of recombinant human chorionic gonadotropin in serum and follicular fluid in woman with high body mass index. Fertil Steril. 2010;93(6):2084–7.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to extend our special thanks to Shabnam Khodabakhshi and Azam Sanati for their help in data collection and data entry.

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Authors and Affiliations

  1. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O Box: 19395-4644, No 12, East Hafez Avenue, Banihashem street, Resalat highway, Tehran, Iran

    Tahereh Madani, Ladan Mohammadi Yeganeh & Zahra Ezabadi

  2. Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

    Fatemeh Hasani

  3. Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

    Mohammad Chehrazi

Authors
  1. Tahereh Madani
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  2. Ladan Mohammadi Yeganeh
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  3. Zahra Ezabadi
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  4. Fatemeh Hasani
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Correspondence to Ladan Mohammadi Yeganeh.

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Capsule

Recombinant hCG shows equivalent efficacy to urinary hCG in terms of the number of oocytes per aspirated follicles in selected patients undergoing ICSI; however, 500 μg rhCG seems to be more advantageous than the lower dose in this indication.

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Madani, T., Mohammadi Yeganeh, L., Ezabadi, Z. et al. Comparing the efficacy of urinary and recombinant hCG on oocyte/follicle ratio to trigger ovulation in women undergoing intracytoplasmic sperm injection cycles: a randomized controlled trial. J Assist Reprod Genet 30, 239–245 (2013). https://doi.org/10.1007/s10815-012-9919-3

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  • DOI: https://doi.org/10.1007/s10815-012-9919-3

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