Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study

Authors: Blockeel, C.; De Vos, M.; Verpoest, W.; Stoop, D.; Haentjens, P.; Devroey, P.

Source: Human Reproduction, Volume 24, Number 11, 4 November 2009 , pp. 2910-2916(7)

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Abstract:

BACKGROUND

GnRH-antagonist protocols shorten the treatment period and reduce inconvenience for IVF patients. This randomised controlled trial (RCT) further explored whether low-dose hCG can be used clinically to replace recombinant FSH (rFSH) during the late follicular phase in a GnRH-antagonist protocol.

METHODS

Seventy ICSI patients undergoing controlled ovarian stimulation (COS) in a GnRH-antagonist protocol was randomized into two groups. The control group received a standard treatment with rFSH (Puregon) plus a GnRH-antagonist, daily from Day 6 of stimulation. In the study group, rFSH was discontinued when six follicles 12 mm were observed and estradiol levels were >600 ng/l; rFSH was subsequently replaced by low-dose hCG (200 IU/l daily).

RESULTS

Mean values (SD) for dose and duration of rFSH treatment in the control versus low-dose hCG group were 1617 (280) versus 1273 (260) IU rFSH [between-group difference 344, 95 confidence interval (CI) 483 to 205; P < 0.001], and 8.2 (1.6) versus 6.4 (1.3) days (1.8, 2.6 to 1.1; P < 0.001), respectively. The mean number of metaphase II oocytes of 10.1 versus 8.9 (between-group difference 1.2, 95 CI 3.9 to 1.5) and the ongoing pregnancy rates of 10/35 (29) versus 13/35 (37) (between-group difference 8.6; 95 CI 13.0 to 29.1; P 0.45) for control versus hCG, respectively, did not differ.

CONCLUSION

In this pilot trial, substitution of rFSH by low-dose hCG in the final days of COS leads to a reduction of FSH consumption whereas ICSI outcome, in terms of oocyte yield and ongoing pregnancy rate, remains comparable to the traditional regimen (ClinicalTrials.gov, trial number: NCT00750100).

Keywords: hCG; recombinant FSH; GnRH antagonist cycle; ICSI; ongoing pregnancy rate

Document Type: Research article

DOI: http://dx.doi.org/10.1093/humrep/dep253

Publication date: 2009-11-04

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Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.

Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study

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