Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization.
OBJECTIVE
The lowest effective hCG dose in high responders during IVF-embryo transfer (ET) has not been established. This study was performed to confirm that a dose of 3,300 IU is sufficient to provide adequate oocyte maturation and fertilization.


METHODS
Retrospective review of IVF clinical data.


METHODS
Infertility center at a tertiary care university.


METHODS
Ninety-four IVF cycles were analyzed from high responders based on peak E(2) levels. Demographics were compared including age, diagnosis, and stimulation protocol.


METHODS
On the day of hCG administration, if E(2) levels were >/=2,500 but <4,000 pg/mL, patients received 5,000 IU (group A). For levels between 4,000 pg/mL and 5,500 IU pg/mL, they received 3,300 IU (group B).


METHODS
Number of oocytes retrieved, proportion of mature oocytes, fertilization rates, chemical and clinical pregnancy rates (PR). The incidence and severity of ovarian hyperstimulation syndrome (OHSS) was also analyzed.


RESULTS
Mean ages were 35.4 +/- 0.7 and 33.2 +/- 0.7 for groups A and B, respectively. Peak E(2) levels differed significantly (2,907 +/- 76 vs. 4,260 +/- 129 pg/mL), as well as the mean number of eggs retrieved (15.9 +/- 0.9 vs. 20.3 +/- 1.2). Proportion of mature eggs (81.6% vs. 81.9%), fertilization rate (70.5% vs. 68.7%), chemical PR (58.7% vs. 58.7%), and clinical PR (50.0% vs. 43.5%) were similar. There was no difference in the incidence of mild, moderate, or severe OHSS.


CONCLUSIONS
A reduced hCG dose of 3,300 IU results in a similar proportion of mature eggs, similar fertilization rates, and similar PRs compared to 5,000 IU. Reducing the dose of hCG does not eliminate the risk of OHSS in a high-risk group.
The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA.
David W
DW
Schmidt
Donald B
DB
Maier
John C
JC
Nulsen
Claudio A
CA
Benadiva
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D008297:Male; D009865:Oocytes / Q000502:physiology; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D004958:Estradiol