ABSTRACT
RESEARCH QUESTION: Does splitting the human chorionic gonadotrophin (HCG) support in IVF cycles triggered by a gonadotrophin-releasing hormone agonist result in a better progesterone profile? DESIGN: Randomized controlled three-arm study, performed at the Fertility Clinic, Odense University Hospital, Denmark. Patients with 12-25 follicles ≥12 mm were randomized into three groups: Group 1 - ovulation triggered with 6500 IU HCG; Group 2 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1500 IU HCG on the day of oocyte retrieval (OCR); and Group 3 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1000 IU HCG on the day of OCR and 500 IU HCG on OCRâ¯+â¯5. All groups received 180 mg vaginal progesterone. Progesterone concentrations were analysed in eight blood samples from each patient. RESULTS: Sixty-nine patients completed the study. Baseline and laboratory data were comparable. Progesterone concentration peaked on OCRâ¯+â¯4 in Groups 1 and 2, and peaked on OCRâ¯+â¯6 in Group 3. On OCRâ¯+â¯6, the progesterone concentration in Group 2 was significantly lower compared with Groups 1 and 3 (Pâ¯=â¯0.003 and P < 0.001, respectively). On OCRâ¯+â¯8, the progesterone concentration in Group 3 was significantly higher compared with the other groups (both P<0.001). Progesterone concentrations were significantly higher in Group 3 from OCRâ¯+â¯6 until OCRâ¯+â¯14 compared with the other groups (all P ≤ 0.003). Four patients developed ovarian hyperstimulation syndrome in Group 3. CONCLUSION: Sequential HCG support after a GnRH agonist trigger provides a better progesterone concentration in the luteal phase.
Subject(s)
Chorionic Gonadotropin , Embryo Transfer , Fertilization in Vitro , Gonadotropin-Releasing Hormone , Ovulation Induction , Progesterone , Humans , Female , Chorionic Gonadotropin/administration & dosage , Gonadotropin-Releasing Hormone/agonists , Adult , Embryo Transfer/methods , Progesterone/blood , Pregnancy , Ovulation Induction/methods , Fertilization in Vitro/methods , Pregnancy Rate , Oocyte Retrieval , Luteal Phase/drug effectsABSTRACT
RESEARCH QUESTION: Is there an association between the ovulation trigger dose of human chorionic gonadotrophin (HCG) and endogenous progesterone production during the luteal phase? DESIGN: This randomized controlled four-arm study, at the Fertility Clinic, Odense University Hospital, Denmark, included women undergoing gonadotrophin-releasing hormone (GnRH) antagonist IVF treatment with ≤11 follicles ≥12 mm. Group 1-3 were triggered with 5000 IU, 6500 IU or 10,000 IU HCG, respectively, receiving 17α-hydroxyprogesterone caproate intramuscularly for luteal-phase support (LPS) to measure endogenous progesterone production. Group 4 received 6500 IU HCG trigger and vaginal progesterone. During the study, the 5000 IU and 10,000 IU HCG groups were switched from urinary to recombinant HCG, as urinary HCG was removed from market. Eight blood samples were drawn during the luteal phase. RESULTS: Ninety-four participants completed the study. There was a significant positive association between the HCG trigger dose and the progesterone at 8 days (P < 0.001), 10 days (P < 0.001) and 14 days (P < 0.001) post-oocyte retrieval. Comparing the groups individually revealed a significant difference in progesterone concentration between low and high trigger doses at 4 days (Pâ¯=â¯0.037) and 8 days (Pâ¯=â¯0.007) post-oocyte retrieval and between all intervention groups at oocyte retrievalâ¯+â¯6 days: group 1 and 2 (Pâ¯=â¯0.011), group 2 and 3 (Pâ¯=â¯0.042) and group 1 and 3 (P < 0.001). Higher HCG trigger dose increased the progesterone from the individual follicle. CONCLUSIONS: Increasing HCG trigger doses significantly increased endogenous progesterone concentration during the mid-late luteal phase.
