TY - JOUR
T1 - The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI
AU - Awonuga, Awoniyi O.
AU - Wheeler, Karen
AU - Thakur, Mili
AU - Jeelani, Roohi
AU - Diamond, Michael P.
AU - Puscheck, Elizabeth E.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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 OpenSPiltSPi 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.
AB - 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 OpenSPiltSPi 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.
KW - Follicles
KW - IVF stimulation
KW - Oocyte retrieval
KW - Superovulation
KW - hCG
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U2 - 10.1007/s10815-017-1056-6
DO - 10.1007/s10815-017-1056-6
M3 - Article
C2 - 28965278
AN - SCOPUS:85030180107
SN - 1058-0468
VL - 35
SP - 289
EP - 295
JO - Journal of Assisted Reproduction and Genetics
JF - Journal of Assisted Reproduction and Genetics
IS - 2
ER -