title: Low-dose human chorionic gonadotropin alone can complete follicle maturity: successful application to modified natural cycle in vitro fertilization.
abstract: OBJECTIVE
  To investigate the feasibility of utilizing low-dose hCG alone to complete follicle maturity in a natural cycle, without the need for antecedent exogenous FSH stimulation.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Academic fertility program.
  
  
  METHODS
  Normally ovulatory women with infertility thought to be predominantly due to male factor.
  
  
  METHODS
  Modified natural IVF cycles were conducted as follows: natural ovulatory cycles were monitored with serial ultrasound examinations and serum E2 determinations. When the lead follicle reached preovulatory status according to cycle day, ultrasound, and E2 levels, 0.25 mg of the GnRH antagonist ganirelix acetate was administered along with 200 IU of hCG. These medications were repeated daily for 2 to 3 days with further serial monitoring. A trigger dose of 10,000 IU of hCG was followed by follicle aspiration, IVF, and ET in a standard manner.
  
  
  METHODS
  Follicle maturity, live births, documentation of the feasibility of this new approach.
  
  
  RESULTS
  In all cases, E2 levels rose and the dominant follicle continued to increase in size in response to low-dose hCG after GnRH antagonist administration. Follicle aspiration yielded one or more mature oocytes. In vitro fertilization and ET resulted in live births.
  
  
  CONCLUSIONS
  Low-dose hCG can be used to complete follicle maturity in a natural cycle without the need for antecedent exogenous FSH stimulation. This finding may have strong clinical utility in modified natural cycle IVF.
authors: USC Fertility, University of Southern California, Los Angeles, California. Electronic address: rpaulson@usc.edu.
authors: Richard J
authors: RJ
authors: Paulson
authors: USC Fertility, University of Southern California, Los Angeles, California.
authors: Karine
authors: K
authors: Chung
authors: Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors: Alexander M
authors: AM
authors: Quaas
authors: Dallas IVF-Plano Fertility Center, Plano, Texas.
authors: Sara J
authors: SJ
authors: Mucowski
authors: USC Fertility, University of Southern California, Los Angeles, California; Kaiser Permanente Medical Center, Los Angeles, California.
authors: Sami I
authors: SI
authors: Jabara
authors: USC Fertility, University of Southern California, Los Angeles, California.
authors: Kristin A
authors: KA
authors: Bendikson
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000628:therapy*; D050498:Live Birth; D054315:Oocyte Retrieval / Q000379:methods; D006080:Ovarian Follicle / Q000187:drug effects* / Q000502:physiology*; D011247:Pregnancy
chemical_list: D006063:Chorionic Gonadotropin
keywords: IVM; hCG boost; low-dose hCG; modified natural cycle IVF; natural cycle IVF