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The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study is to determine whether continued stimulation of mature follicles to allow “catch up” growth of medium-sized follicles in assisted reproductive technology compromises the clinical pregnancy (CPR) and live birth (LBR) rates in IVF/ICSI cycles.

Methods

This retrospective cohort study reviewed 200 first IVF ± ICSI cycles out of a total of 340 cycles with complete data. Women underwent stimulation protocols with gonadotropins (Gn) and GnRH antagonist. Treatment cycles were divided into two groups (Gp): hCG administration delayed despite the presence of two mature follicles, defined as ≥ 18 mm [Gp1, n = 79] and hCG administration given when there were two mature follicles [Gp2, n = 121].

Results

The patients in Gp1 were significantly younger than those in Gp2 [32.9 (4.5) vs. 34.3 (4.8), p = 0.04] and needed a median of one more day of superovulation before ovulation was triggered with hCG. The extra days was associated with the use of 450 [75–2025] more Gn, such that at the time the hCG was administered, patient’s in group 1 had developed significantly greater number of follicles ≥ 18 mm [mean (SD), 4.9 (1.8) vs. 3.4 (1.7), p < 0.0001]. The clinical pregnancy (48.1 vs. 38.0%, [OR (95% CI)] [1.6 (1.0–2.5), p = 0.09]) and live birth (43.0 vs. 35.5%, [1.4 (0.9–2.3), p = 0.21]) rates per cycle started were not significantly different between the two groups. Forward stepwise logistic regression showed that only maternal age (p = 0.04) influenced clinical pregnancy rates (OR = 0.88, CI 0.78–0.99) and only the number of days for superovulation influenced live birth rates (OR = 0.65, CI 0.486–0.869).

Conclusion

This study demonstrated that delaying hCG administration to allow further growth of the medium-sized follicles added further days of superovulation and cost without improvement in CPR and LBR.

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Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Detroit Medical Center, 275 E. Hancock Street, Detroit, MI, 48201, USA

    Awoniyi O. Awonuga, Karen Wheeler, Mili Thakur, Roohi Jeelani & Elizabeth E. Puscheck

  2. Division of Genetic and Metabolic Disorders, Department of Pediatrics and Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA

    Mili Thakur

  3. Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA

    Michael P. Diamond

Authors
  1. Awoniyi O. Awonuga
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  2. Karen Wheeler
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  3. Mili Thakur
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  4. Roohi Jeelani
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  6. Elizabeth E. Puscheck
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Correspondence to Awoniyi O. Awonuga.

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Awonuga, A.O., Wheeler, K., Thakur, M. et al. The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI. J Assist Reprod Genet 35, 289–295 (2018). https://doi.org/10.1007/s10815-017-1056-6

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  • DOI: https://doi.org/10.1007/s10815-017-1056-6

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