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

Awoniyi O. Awonuga, Karen Wheeler, Mili Thakur, Roohi Jeelani, Michael Peter Diamond, Elizabeth E. Puscheck

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalJournal of Assisted Reproduction and Genetics
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Superovulation
Intracytoplasmic Sperm Injections
Live Birth
Pregnancy Rate
Gonadotropins
Pregnancy
Assisted Reproductive Techniques
Birth Rate
Maternal Age
Growth
Ovulation
Gonadotropin-Releasing Hormone
Cohort Studies
Retrospective Studies
Logistic Models
Costs and Cost Analysis
Therapeutics

Keywords

  • Follicles
  • IVF stimulation
  • Oocyte retrieval
  • Superovulation
  • hCG

ASJC Scopus subject areas

  • Reproductive Medicine
  • Genetics
  • Obstetrics and Gynecology
  • Developmental Biology
  • Genetics(clinical)

Cite this

The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI. / Awonuga, Awoniyi O.; Wheeler, Karen; Thakur, Mili; Jeelani, Roohi; Diamond, Michael Peter; Puscheck, Elizabeth E.

In: Journal of Assisted Reproduction and Genetics, Vol. 35, No. 2, 01.02.2018, p. 289-295.

Research output: Contribution to journalArticle

Awonuga, Awoniyi O. ; Wheeler, Karen ; Thakur, Mili ; Jeelani, Roohi ; Diamond, Michael Peter ; Puscheck, Elizabeth E. / The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI. In: Journal of Assisted Reproduction and Genetics. 2018 ; Vol. 35, No. 2. pp. 289-295.
@article{7eadea9417ec49e18ead9a0bcb2790e0,
title = "The value of delaying hCG administration to enable maturation of medium-sized follicles in patients undergoing superovulation for IVF/ICSI",
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 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.",
keywords = "Follicles, IVF stimulation, Oocyte retrieval, Superovulation, hCG",
author = "Awonuga, {Awoniyi O.} and Karen Wheeler and Mili Thakur and Roohi Jeelani and Diamond, {Michael Peter} and Puscheck, {Elizabeth E.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1007/s10815-017-1056-6",
language = "English (US)",
volume = "35",
pages = "289--295",
journal = "Journal of Assisted Reproduction and Genetics",
issn = "1058-0468",
publisher = "Springer New York",
number = "2",

}

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 Peter

AU - Puscheck, Elizabeth E.

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

UR - http://www.scopus.com/inward/record.url?scp=85030180107&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030180107&partnerID=8YFLogxK

U2 - 10.1007/s10815-017-1056-6

DO - 10.1007/s10815-017-1056-6

M3 - Article

C2 - 28965278

AN - SCOPUS:85030180107

VL - 35

SP - 289

EP - 295

JO - Journal of Assisted Reproduction and Genetics

JF - Journal of Assisted Reproduction and Genetics

SN - 1058-0468

IS - 2

ER -