Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF
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RESEARCH
Open Access
Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF Hala Gomaa1,2,3, Robert F Casper1,2,3, Navid Esfandiari1,2, Paul Chang1,2 and Yaakov Bentov1,2,3*
Abstract Background: To compare the outcome of IVF cycles in women receiving controlled ovarian stimulation with recFSH or recFSH plus low dose hCG. Methods: A retrospective case control study, performed at a private practice affiliated with an academic institute. Patients were infertile women who were treated with IVF/ICSI and controlled ovarian stimulation in a long GnRH agonist protocol using either low dose hCG in addition to recFSH [N = 88] or recFSH alone [N = 99]. Primary outcomes were mean FSH dose, number of mature eggs, number of fertilized eggs, and serum levels of estradiol. Secondary outcomes were endometrial thickness, cycle cancellations and pregnancy rates. Results: A significant increase in number of mature and fertilized eggs was observed in women over 40 years of age using low dose hCG in addition to recFSH. The estradiol level was significantly higher on the day of hCG administration and the serum level of FSH on cycle day 7 and on the day of hCG administration were lower. Conclusion: Addition of low dose hCG to recFSH compared with recFSH alone significantly modified cycle characteristics in patients >/= 40 years and could be of potential benefit for IVF cycles in older infertile women. Keywords: Low dose hCG, In vitro fertilization, Ovarian stimulation, Oocyte maturation, Cost of treatment
Background Major advancements have been made in the treatment of infertility over the past three decades. Multiple trials have been conducted in order to achieve safe, effective, and low cost treatment protocol for controlled ovarian stimulation (COS) in patients undergoing IVF/ICSI. Despite these developments, the age of the female patient is still considered the most important prognostic factor for both response to COS and for pregnancy outcome [1,2]. The most important hormone in the stimulation of ovarian folliculogenesis is FSH [3]. There is controversy about the importance of luteinizing hormone (LH) in ovarian stimulation, although some studies have shown that LH may improve ovarian response, in particular for older women [4]. Another study showed that the use of recLH in GnRH antagonist cycles improved the implantation rate in older patients [5]. This beneficial effect was * Correspondence: [email protected] 1 Toronto Centre for Advanced Reproductive Technology, M5X 2 S9, Toronto, ON, Canada 2 Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada Full list of author information is available at the end of the article
not seen with a microdose flare protocol [6]. The selective contribution of LH to the outcome of IVF treatment in older patients, has also been validated in a Cochrane meta-analysis [7]. LH and hCG share structural similarities and function through the same receptor [8]. The half-life of hCG is longer (2.32 days) tha
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