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Hosseinisadat, R., Saeed, L., Ashourzadeh, S., Safar Heidari, S., & Habibzadeh, V. (2021). Effects of human chorionic gonadotropin intrauterine injection on oocyte retrieval day on assisted reproductive techniques outcomes: An RCT. International Journal of Reproductive BioMedicine (IJRM), 19(9), 773-780. https://doi.org/10.18502/ijrm.v19i9.9709
https://doi.org/10.18502/ijrm.v19i9.9709
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- Cited by 3 articles
authors
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Robabe Hosseinisadat
Robabe Hosseinisadat
Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Lida Saeed
Lida Saeed
Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Sareh Ashourzadeh
Sareh Ashourzadeh
Kerman Infertility Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Sedigheh Safar Heidari
Sedigheh Safar Heidari
Kerman Infertility Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Victoria Habibzadeh
Victoria Habibzadeh
Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Published Date
- Oct 10, 2021
Effects of human chorionic gonadotropin intrauterine injection on oocyte retrieval day on assisted reproductive techniques outcomes: An RCT
Abstract
Background: Several mediators play an important role in implantation. One of these mediators is human chorionic gonadotropin (HCG).
Objective: To evaluate the effects of HCG intrauterine injection on the day of oocyte retrieval on the result of assisted reproductive techniques (ART).
Materials and Methods: In this randomized clinical trial study, 126 women who were referred to Afzalipour Infertility Center between December 2018 to December 2019 undergoing in vitro fertilization/intracytoplasmic sperm injection cycles were enrolled and assigned to two groups of: a case (n = 62) and a control group (n = 64). The protocols for both groups were the same; except that the case group was injected with the protocols for both groups were the same, except that the case group was injected with 1000 IU of HCG into uterine cavity following the oocyte puncture, while no medication was administered to the control group. The implantation rate, chemical pregnancy, clinical pregnancy, and abortion rates were compared between the two groups.
Results: Positive chemical pregnancy was seen in 15 (27.3%) cases of the case group and 14 (25.5%) of the control group. No significant difference was seen in the chemical and clinical pregnancy rates between the groups. The abortion rate was higher in the control group but that was not significant.
Conclusion: A 1000 IU of HCG intrauterine injection after oocyte retrieval does not improve implantation, chemical or clinical pregnancy rates in ART cycles. Further studies are needed to clearly understand the role of HCG intrauterine injection in the day of oocyte retrieval in ART outcomes.
Key words: Oocyte retrieval, Chorionic gonadotropin, Pregnancy, Assisted reproductive techniques.
References
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[12] Makrigiannakis A, Vrekoussis T, Zoumakis E, Kalantaridou SN, Jeschke U. The role of HCG in implantation: A minireview of molecular and clinical evidence. Int J Mol Sci 2017; 18: 1305. 1–8.
[13] Xu B, Zhang Q, Hao J, Xu D, Li Y. Two protocols to treat thin endometrium with granulocyte colony-stimulating factor during frozen embryo transfer cycles. Reprod Biomed Online 2015; 30: 349–358.
[14] Rezaee D, Bandehpour M, Kazemi B, Salehi M. Role of intrauterine administration of transfected peripheral blood mononuclear cells by GM-CSF on embryo implantation and pregnancy rate in mice. Mol Hum Reprod 2020; 26: 101–110.
[15] Aaleyasin A, Aghahosseini M, Rashidi M, Safdarian L, Sarvi F, Najmi Z, et al. In vitro fertilization outcome following embryo transfer with or without preinstillation of human chorionic gonadotropin into the uterine cavity: A randomized controlled trial. Gynecol Obstet Invest 2015; 79: 201–205.
[16] Dehghani Firouzabadi R, Janati S, Razi MH. The effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: A randomized clinical trial. Int J Reprod Biomed 2016; 14: 657–664.
[17] Mansour R, Tawab N, Kamal O, El-Faissal Y, Serour A, Aboulghar M, et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection: A prospective randomized study. Fertil Steril 2011; 96: 1370–1374. e1.
[18] Fernandez-Tejada A, Vadola PA, Danishefsky SJ. Chemical synthesis of the beta-subunit of human luteinizing (hLH) and chorionic gonadotropin (hCG) glycoprotein hormones. J Am Chem Soc 2014; 136: 8450–8458.
[19] Casarini L, Santi D, Brigante G, Simoni M. Two hormones for one receptor: Evolution, biochemistry, actions, and pathophysiology of LH and hCG. Endocr Rev 2018; 39: 549–592.
[20] Srivastava A, Sengupta J, Kriplani A, Roy KK, Ghosh D. Profiles of cytokines secreted by isolated human endometrial cells under the influence of chorionic gonadotropin during the window of embryo implantation. Reproductive Biology and Endocrinology 2013; 11: 116. 1–15.
[21] Weimar CH, Post Uiterweer ED, Teklenburg G, Heijnen CJ, Macklon NS. Reprint of: In-vitro model systems for the study of human embryo-endometrium interactions. Reprod Biomed Online 2013; 27: 673–688.
[22] Ng YH, Rome S, Jalabert A, Forterre A, Singh H, Hincks CL, et al. Endometrial exosomes/microvesicles in the uterine microenvironment: A new paradigm for embryoendometrial cross talk at implantation. PloS One 2013; 8: e58502.
[23] Tapia-Pizarro A, Archiles S, Argandona F, Valencia C, Zavaleta K, Cecilia Johnson M, et al. hCG activates Epac-Erk1/2 signaling regulating progesterone receptor expression and function in human endometrial stromal cells. Mol Hum Reprod 2017; 23: 393–405.
[24] Gao M, Jiang X, Li B, Li L, Duan M, Zhang X, et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer can improve in vitro fertilizationembryo transfer outcomes: A meta-analysis of randomized controlled trials. Fertil Sterili 2019; 112: 89–97.e1.
[25] Hong KH, Forman EJ, Werner MD, Upham KM, Gumeny CL, Winslow AD, et al. Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: A randomized, doubleblind, placebo-controlled trial. Fertil Steril 2014; 102: 1591– 1595. e2.
[26] Xu Z, Chen W, Chen C, Xiao Y, Chen X. Effect of intrauterine injection of human chorionic gonadotropin before frozen-thawed embryo transfer on pregnancy outcomes in women with endometriosis. J Int Med Res 2019; 47: 2873–2880.
[27] Zhang Ch, Yang Ch, Li N, Liu X, He J, Chen X, et al. Elevated insulin levels compromise endometrial decidualization in mice with decrease in uterine apoptosis in early-stage pregnancy. Arch Toxicol 2019; 93: 3601– 3615.
[2] Huang P, Wei L, Li X, Qin A. Effects of intrauterine perfusion of human chorionic gonadotropin in women with different implantation failure numbers. Am J Reprod Immunol 2018; 79: e12809.
[3] Messaoudi S, El Kasmi I, Bourdiec A, Crespo K, Bissonnette L, Le Saint C, et al. 15 years of transcriptomic analysis on endometrial receptivity: What have we learnt? Fertility Research and Practice 2019; 5: 9.
[4] Huang P, Wei L, Li X. A study of intrauterine infusion of human chorionic gonadotropin (hCG) before frozenthawed embryo transfer after two or more implantation failures. Gynecol Endocrinol 2017; 33: 67–69.
[5] Monti M, Lupoli R, Sosa Fernandez LMS, Cirillo F, Di Minno MNDD. Association of human leukocyte antigen-G 14 bp polymorphism with recurrent pregnancy loss in European 2019; 112: 577–585. e3.
[6] Evans J, Rai A, Nguyen HPT, Poh QH, Elglass K, Simpson RJ, et al. Human endometrial extracellular vesicles functionally prepare human trophectoderm model for implantation: Understanding bidirectional maternal−embryo communication. Proteomics 2019; 19: e1800423.
[7] Beltrame JS, Sordelli MS, Canumil VA, Alonso CAI, Perez Martinez S, Ribeiro ML. Steroid hormones induce in vitro human first trimester trophoblast tubulogenesis by the lysophosphatidic acid pathway. Mol Cell Endocrinol 2018; 478: 126–132.
[8] Ciavattini A, Delli Carpini G, Clemente N, Moriconi L, Gentili C, Di Giuseppe J. Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: An observational study. Fertil Steril 2016; 105: 1255–1260.
[9] Tapia-Pizarro A, Argandona F, Palomino WA, Devoto L. Human chorionic gonadotropin (hCG) modulation of TIMP1 secretion by human endometrial stromal cells facilitates extravillous trophoblast invasion in vitro. Hum Reprod 2013; 28: 2215–2227.
[10] Chang TA, Bondarenko GI, Gerami-Naini B, Drenzek JG, Durning M, Garthwaite MA, et al. Trophoblast differentiation, invasion and hormone secretion in a three-dimensional in vitro implantation model with rhesus monkey embryos. Reprod Biol Endocrinol 2018; 16: 24. 1– 12.
[11] Yu N, Zhang B, Xu M, Wang S, Liu R, Wu J, et al. Intrauterine administration of autologous peripheral blood mononuclear cells (PBMCs) activated by HCG improves the implantation and pregnancy rates in patients with repeated implantation failure: A prospective randomized study. Am J Reprod Immunol 2016; 76: 212–216.
[12] Makrigiannakis A, Vrekoussis T, Zoumakis E, Kalantaridou SN, Jeschke U. The role of HCG in implantation: A minireview of molecular and clinical evidence. Int J Mol Sci 2017; 18: 1305. 1–8.
[13] Xu B, Zhang Q, Hao J, Xu D, Li Y. Two protocols to treat thin endometrium with granulocyte colony-stimulating factor during frozen embryo transfer cycles. Reprod Biomed Online 2015; 30: 349–358.
[14] Rezaee D, Bandehpour M, Kazemi B, Salehi M. Role of intrauterine administration of transfected peripheral blood mononuclear cells by GM-CSF on embryo implantation and pregnancy rate in mice. Mol Hum Reprod 2020; 26: 101–110.
[15] Aaleyasin A, Aghahosseini M, Rashidi M, Safdarian L, Sarvi F, Najmi Z, et al. In vitro fertilization outcome following embryo transfer with or without preinstillation of human chorionic gonadotropin into the uterine cavity: A randomized controlled trial. Gynecol Obstet Invest 2015; 79: 201–205.
[16] Dehghani Firouzabadi R, Janati S, Razi MH. The effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: A randomized clinical trial. Int J Reprod Biomed 2016; 14: 657–664.
[17] Mansour R, Tawab N, Kamal O, El-Faissal Y, Serour A, Aboulghar M, et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection: A prospective randomized study. Fertil Steril 2011; 96: 1370–1374. e1.
[18] Fernandez-Tejada A, Vadola PA, Danishefsky SJ. Chemical synthesis of the beta-subunit of human luteinizing (hLH) and chorionic gonadotropin (hCG) glycoprotein hormones. J Am Chem Soc 2014; 136: 8450–8458.
[19] Casarini L, Santi D, Brigante G, Simoni M. Two hormones for one receptor: Evolution, biochemistry, actions, and pathophysiology of LH and hCG. Endocr Rev 2018; 39: 549–592.
[20] Srivastava A, Sengupta J, Kriplani A, Roy KK, Ghosh D. Profiles of cytokines secreted by isolated human endometrial cells under the influence of chorionic gonadotropin during the window of embryo implantation. Reproductive Biology and Endocrinology 2013; 11: 116. 1–15.
[21] Weimar CH, Post Uiterweer ED, Teklenburg G, Heijnen CJ, Macklon NS. Reprint of: In-vitro model systems for the study of human embryo-endometrium interactions. Reprod Biomed Online 2013; 27: 673–688.
[22] Ng YH, Rome S, Jalabert A, Forterre A, Singh H, Hincks CL, et al. Endometrial exosomes/microvesicles in the uterine microenvironment: A new paradigm for embryoendometrial cross talk at implantation. PloS One 2013; 8: e58502.
[23] Tapia-Pizarro A, Archiles S, Argandona F, Valencia C, Zavaleta K, Cecilia Johnson M, et al. hCG activates Epac-Erk1/2 signaling regulating progesterone receptor expression and function in human endometrial stromal cells. Mol Hum Reprod 2017; 23: 393–405.
[24] Gao M, Jiang X, Li B, Li L, Duan M, Zhang X, et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer can improve in vitro fertilizationembryo transfer outcomes: A meta-analysis of randomized controlled trials. Fertil Sterili 2019; 112: 89–97.e1.
[25] Hong KH, Forman EJ, Werner MD, Upham KM, Gumeny CL, Winslow AD, et al. Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: A randomized, doubleblind, placebo-controlled trial. Fertil Steril 2014; 102: 1591– 1595. e2.
[26] Xu Z, Chen W, Chen C, Xiao Y, Chen X. Effect of intrauterine injection of human chorionic gonadotropin before frozen-thawed embryo transfer on pregnancy outcomes in women with endometriosis. J Int Med Res 2019; 47: 2873–2880.
[27] Zhang Ch, Yang Ch, Li N, Liu X, He J, Chen X, et al. Elevated insulin levels compromise endometrial decidualization in mice with decrease in uterine apoptosis in early-stage pregnancy. Arch Toxicol 2019; 93: 3601– 3615.