Single‐dose pharmacokinetic study comparing the pharmacokinetics of recombinant human chorionic gonadotropin in healthy Japanese and Caucasian women and recombinant human chorionic gonadotropin and urinary human chorionic gonadotropin in healthy Japanese women

Purpose

Recombinant hCG (r‐hCG) was approved in Japan in 2016. As a prerequisite for a Phase III study in Japan related to this approval, the pharmacokinetic (PK) profile of r‐hCG was investigated.

Methods

An open‐label, partly randomized, single‐center, single‐dose, group‐comparison, Phase I PK‐bridging study was done that compared a single 250 μg dose of r‐hCG with a single 5000 IU dose of urinary hCG (u‐hCG) in healthy Japanese women, as well as comparing a single 250 μg dose of r‐hCG in Japanese and Caucasian women. The Japanese participants were randomized 1:1 to receive either r‐hCG or u‐hCG, while the Caucasian participants were weight‐matched to the Japanese participants who were receiving r‐hCG in a 1:1 fashion. The primary PK parameters were the area under the serum concentration–time curve from time 0 extrapolated to infinity (AUC_0–∞) and the maximum serum concentration (C_max).

Results

The mean serum hCG concentration–time profiles of r‐hCG in the Japanese and Caucasian participants were a similar shape, but the level of overall exposure was ~20% lower in the Japanese participants. For the Japanese participants, r‐hCG resulted in an 11% lower C_max but a 19% higher AUC_0–∞ compared with u‐hCG. No new safety signal was identified.

Conclusion

This study cannot exclude a potential difference in the PK profile of r‐hCG between Japanese and Caucasian participants. However, this study does not indicate that there are clinically relevant differences in the serum PK of r‐hCG and u‐hCG in the Japanese participants.     

Tripling of serum progesterone (P4) and embryonic morphological features in conception and nonconception cycles,after human in vitro fertilization

A series of 26 in vitro fertilization (IVF) cycles was studied for changes of serum progesterone levels before and after injection of human chorionic gonadotropin (hCG) by a comparison of the number of follicles punctured, number of oocytes recovered, morphological features of oocytes, fertilization rate, cleavage rate, and quality of embryos before their transfer. Subjects were further divided into three groups according to their pregnancy outcome. Five pregnancies were generated and reached the stage of clinical confirmation of live baby delivery or live fetus by ultrasound scanning of the uterine contents. Six patient cycles that had a prolonged luteal phase and -hCG levels greater than 40 MIU/ml were described as biochemical pregnancies. Fifteen patient cycles showed no sign of pregnancy. The significant finding of this study is related to the serum progesterone level increase from 20 to 34 hr after hCG injection. The nonpregnancy group yielded a 1.2-fold increase compared with the biochemical pregnancy and pregnancy groups, which had a 3-fold increase. The usage of this multiple effect of progesterone may aid in the prediction of the high-quality embryo that might result from a given treatment cycle, indicate the completion of luteinization, the proper timing of hCG to induce final oocyte maturation, and the necessary length of preincubation, and aid in the prediction as to whether or not a pregnancy is likely to result.     

Nicked human chorionic gonadotropin in trophoblastic disease

Abstract. Kohorn EI, Cole L. Nicked human chorionic gonadotropin in trophoblastic disease.
The objectives of this study were to determine: 1) whether high proportions of nicked human chorionic gonadotropin (hCG) in serum at the time of mole evacuation and during postmolar surveillance is indicative of trophoblastic malignancy and 2) to investigate whether measurement of nicked hCG provides clinically more useful information in the management of patients with trophoblastic disease than does measurement of total hCG alone.
"Tumor marker" total hCG, intact hCG, and nicked hCG were measured in serial samples of serum from our serum bank of patients with representative types of trophoblastic disease. "Tumor marker" hCG has been shown to measure all aspects of the hCG molecule. At the time of presentation of all 45 patients, 83.5% of hCG was intact and 16.5% was nicked. These proportions became reversed as hCG declined either spontaneously after hydatidiform mole evacuation or with chemotherapy in patients with postmolar trophoblastic tumor or with metastatic trophoblastic disease.
We conclude that the proportion of nicked hCG compared to intact hCG increases with trophoblastic disease resolution. Measurement of nicked hCG adds no useful clinical information to that provided by reliable measurement of total hCG.     

Human chorionic gonadotropin as a measure of pregnancy duration

Objective

To compare gestational age (GA) estimates in early pregnancy, determined by last menstrual period (LMP), human chorionic gonadotropin (hCG) concentration, ultrasound crown–rump length (Hadlock formula), and ovulation day (luteinizing hormone surge plus 1 day).

Methods

Female volunteers seeking to conceive (at 5 US sites) collected daily early-morning urine for up to 3 menstrual cycles. Pregnant women underwent ultrasound dating scans. Conception cycle urine was quantitatively assessed for luteinizing hormone and hCG. Summary statistics for GA using each reference method were determined (n = 131).

Results

Correlation between GA determined by ultrasound and ovulation day was excellent (maximum difference 10 days); however, pregnancies dated by ultrasound were 3 days advanced. The difference between LMP estimates and estimates based on ovulation day or ultrasound was 9 and 12 days, respectively. A uniform rise in hCG on each day of pregnancy was seen using all reference methods. The accuracy of hCG measurement in determining the week since conception was more than 93%.

Conclusion

Methods for establishing pregnancy duration vary in their accuracy and their GA estimates. The rise in hCG concentration in early pregnancy is uniform and therefore hCG levels provide the most accurate, early estimation of GA in single, viable pregnancies.ClinicalTrials.gov:NCT01077583     

Substituting human chorionic gonadotropin by gonadotropin-releasing hormone agonist to trigger final follicular maturation,during controlled ovarian hyperstimulation,results in less systemic inflammation

Background.?To investigate the degree of systemic inflammation, as reflected by serum C-reactive protein (CRP) levels, associated with controlled ovarian hyperstimulation (COH) with human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) agonist for the induction of final follicular maturation.

Design.?Prospective, observational study.

Setting.?An in vitro fertilization (IVF) unit of an academic medical center.

Patients.?Twenty-four women undergoing COH and IVF with the flexible GnRH antagonist protocol were prospectively assigned to receive hCG or GnRH agonist for the induction of final follicular maturation.

Methods.?Blood was drawn three times during COH for measurement of sex-steroid and CRP levels: the day on which adequate suppression was obtained (Day-0); the day of or prior to administration of hCG (Day-hCG); and (3) the day of ovum pick-up (Day-OPU). Levels were compared among the three time points in the two groups.

Results.?No between-group differences were observed in terms of patient age, gonadotropin dosage, duration of stimulation or number of oocytes retrieved. Serum CRP levels were significantly higher on Day-OPU than on Day-hCG and Day-0, but the difference was significant only in the hCG group (p<0.03 for both). The percentage change in CRP levels after hCG administration (Day-OPU vs. Day-hCG) (96%) was higher than that after GnRH administration (23%).

Conclusion.?Administration of GnRH agonist in patients undergoing COH for IVF yields a lesser degree of systemic inflammation, as reflected by CRP levels, than hCG.     

Efficacy of low-dose hCG in late follicular phase in controlled ovarian stimulation using GnRH agonist protocol

Objective

Safe, simple and cost-effective protocol is an important goal in ART cycles. The aim of this prospective study was whether administration of low-dose hCG in late follicular phase can be used clinically to replace gonadotropin administration in GnRH long protocol.

Materials and methods

122 patients who were candidates for ART enrolled the study and randomly divided into two groups. The control group (n?=?62) received standard long protocol and gonadotropin administration continued until the day of hCG injection (10,000?IU) for final follicular maturation. The study group (n?=?60) received GnRH long protocol and when at least ??6 follicles with mean diameter ??12?mm were observed in both ovaries, hMG was displaced by 200?IU per day of hCG until final follicular maturation.

Results

There were no significant differences in age, basal FSH, infertility duration and infertility etiology between two groups. There were no statistically significant differences between two groups regarding chemical pregnancy, clinical pregnancy, ongoing pregnancy, and abortion per cycle (50, 40, 40, and 20?% in study group vs. 45.2, 35.5, 35.5, and 21.4?% in control group, respectively). Mean dose of used gonadotropins was significantly higher in control group than that in the study group (2,524?±?893?IU in control group and 1,439?±?433?IU in study group) (p?=?0.000).

Conclusion

According to our data, we recommend the use of low-dose hCG in GnRH long protocol because of lower doses of used gonadotropins.     

Guideline No. 315: Prevention of Ovarian Hyperstimulation Syndrome

Summary Statements

• 1.The particular follicle-stimulating hormone formulation used for ovarian stimulation does not affect the incidence of ovarian hyperstimulation syndrome. (I)
• 2.Coasting may reduce the incidence of severe ovarian hyperstimulation syndrome. (III)
• 3.Coasting for longer than 3 days reduces in vitro fertilization pregnancy rates. (II-2)
• 4.The use of either luteinizing hormone or human chorionic gonadotropin for final oocyte maturation does not influence the incidence of ovarian hyperstimulation syndrome. (I)
• 5.There is no clear published evidence that lowering the human chorionic gonadotropin dose will result in a decrease in the rate of ovarian hyperstimulation syndrome. (III)
• 6.Cabergoline starting from the day of human chorionic gonadotropin reduces the incidence of ovarian hyperstimulation syndrome in patients at higher risk and does not appear to lower in vitro fertilization pregnancy rates. (II-2)
• 7.Avoiding pregnancy by freezing all embryos will prevent severe prolonged ovarian hyperstimulation syndrome in patients at high risk. (II-2)
• 8.Pregnancy rates are not affected when using gonadotropin-releasing hormone (GnRH) agonists in GnRH antagonist protocols for final egg maturation when embryos are frozen by vitrification for later transfer. (II-2)

Recommendations

• 1.The addition of metformin should be considered in patients with polycystic ovarian syndrome who are undergoing in vitro fertilization because it may reduce the incidence of ovarian hyperstimulation syndrome. (I-A)
• 2.Gonadotropin dosing should be carefully individualized, taking into account the patient’s age, body mass, antral follicle count, and previous response to gonadotropins. (II-3B)
• 3.Cycle cancellation before administration of human chorionic gonadatropin is an effective strategy for the prevention of ovarian hyperstimulation syndrome, but the emotional and financial burden it imposes on patients should be considered before the cycle is cancelled. (III-C)
• 4.Gonadotropin-releasing hormone (GnRH) antagonist stimulation protocols are recommended in patients at high risk for ovarian hyperstimulation syndrome (OHSS). The risk of severe OHSS in patients on GnRH antagonist protocols who have a very robust ovarian stimulation response can be reduced by using a GnRH agonist as a substitute for human chorionic gonadotropin to trigger final oocyte maturation. (I-B)
• 5.A gonadotropin-releasing hormone (GnRH) antagonist protocol with a GnRH agonist trigger for final oocyte maturation is recommended for donor oocyte and fertility preservation cycles. (III-C)
• 6.Albumin or other plasma expanders at the time of egg retrieval are not recommended for the prevention of ovarian hyperstimulation syndrome. (I-E)
• 7.Elective single embryo transfer is recommended in patients at high risk for ovarian hyperstimulation syndrome. (III-C)
• 8.Progesterone, rather than human chorionic gonadotropin, should be used for luteal phase support. (I-A)
• 9.Outpatient culdocentesis should be considered for the prevention of disease progression in severe ovarian hyperstimulation syndrome. (II-2B)

     

人绒毛膜促性腺激素(hCG)避孕疫苗临床研究概况

目的:人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)是近30年发展免疫避孕疫苗的首选抗原。以hCG的全β亚基为免疫原和以C末端109~145的37个氨基酸肽段为免疫原研制的避孕疫苗,通过了临床前的毒性与安全性试验,并完成了第一期、第二期临床试验。本文介绍hCG避孕疫苗在国际上的临床研究以及我国临床前预初试验的概况。     

Study of the pharmacokinetics of human chorionic gonadotropin and its relation to ovulation

The pharmacokinetics of human chorionic gonadotropin (hCG) was studied in 15 normal volunteers and 15 patients undergoing in vitro fertilization (IVF). Each subject received 6000 IU hCG, intramuscularly (im), at midcycle, and serum was assayed for hCG frequently for 16 hr. All 30 subjects achieved hCG concentrations 10 IU/liter within 2 hr and 19 (63%) did so within 1 hr of injection. The time taken to attain concentrations of 20 and 40 IU/liter correlated positively with the subjects' weight and/or surface area, but the correlation was not strong. Eleven of the 15 IVF patients had oocytes retrieved 34–35+hr post hCG. Three of the 11 showed evidence of prior undetected ovulation at the time of surgery (definite in one, presumed in two). Taking into consideration the pharmacokinetics of hCG and other factors that could lead to undetected ovulation, the authors conclude that (1) hCG is rapidly absorbed in the majority of subjects following im injection, (2) ovulation may occur earlier than 36 hr following hCG in some individuals, and (3) implementation of a shorter (than 35 hr) hCG-to-oocyte retrieval interval would be advised if undetected ovulation is to be avoided.     

Does luteal phase support by human chorionic gonadotropin improve pregnancy outcomes in frozen-thawed embryo transfer cycles?

Objective

The present study was aimed to investigation the effect of human chorionic gonadotropin (hCG) administration on the implantation and pregnancy outcomes in the frozen-thawed embryo transfer (FET) cycles.

Subpopulations of Human Granulosa–Luteal Cells Obtained from Gonadotropin- or Gonadotropin-Releasing Hormone Agonist/ Gonadotropin-Treated Follicles in In Vitro Fertilization–Embryo Transfer Cycles

Purpose: Our purpose was to find the differences in granulosa–luteal cells obtained from gonadotropin- versus gonadotropin-releasing hormone (GnRH) agonist/gonadotropin-treated follicles in in vitro fertilization–embryo transfer (IVF-ET) cycles. Methods: Granulosa–luteal cells were obtained from 45 follicles of women undergoing IVF-ET with gonadotropin releasing hormone (GnRH) agonist and human menopausal gonadotropin (hMG) and from 45 follicles of women with hMG IVF-ET cycles. Subpopulations of granulosa–luteal cells were observed by computerized image analysis in which human chorionic gonadotropin (hCG) was localized using immunoperoxidase staining. Results: The luteinized granulosa–luteal cells from hMG-treated follicles were larger than those from GnRH agonist/hMG-treated follicles. The hMG-treated follicles contained more hCG-stained cells, particularly those with cytoplasmic hCG localization. Conclusions: We found differences in morphometric characteristics and hCG localization in granulosa–luteal cells obtained from hMG- versus GnRH agonist/hMG-treated follicles. We presume that the results indicate the influence and importance of luteal-phase support on the clinical pregnancy rate in GnRH agonist/hMG-treated IVF-ET cycles.     

Analysis of Implantation in Assisted Reproduction Through the Use of Serial Human Chorionic Gonadotropin Measurements

Purpose: Our purpose was to examine implantation of singleton pregnancies achieved following various assisted reproductive technologies (ARTs) through the appearance and rising titers of serum human chorionic gonadotropin (hCG) levels. Methods: A total of 114 singleton pregnancies resulting from in vitro fertilization and intrauterine insemination was analyzed. Patients were divided into five groups according to the type of ovarian stimulation protocol [gonadotropin stimulation with/without the use of gonadotropin-releasing hormone agonist (GnRHa), long protocol, or flare-up technique] and to the day of embryo transfer (day 2 or day 3 after oocyte retrieval). Serial serum hCG levels were measured between 10 and 25 days after fertilization and log-transformed. Linear regression analyses were performed and extrapolated to hCG = 10 mIU/ml (hCG ₁₀ ), which was used as an estimate of detectable implantation. The slopes of the regression lines were used to estimate the rising speed of hCG. Results: There were no significant differences in the days of hCG in maternal serum to reach 10 mIU/ml (implantation) or in the slopes of the regression lines for all five studied groups. Conclusions: The appearance of hCG in maternal serum was used to assess the time of clinically detectable implantation. Furthermore, because hCG production is a marker of trophoblastic activity, its serum doubling time was used as an indicator of embryo quality. Results showed that in various ART protocols with and without GnRHa, there were no significant differences in implantation time or embryo quality. Embryo development in early pregnancy follows a preprogrammed-timing schedule and depends mainly on the embryonic age of the health, successfully implanted conceptus.     

Luteinizing response to human chorionic gonadotropin does not predict outcome in gonadotropin releasing hormone agonist-suppressed/human menopausal gonadotropin-stimulated in vitro fertilization (IVF) cycles

Objective The purpose of this study was to determine if early luteinizing potential in gonadotropin releasing hormone agonist (GnRH-a)-suppressed/human menopausal gonadotropin (hMG)-stimulated IVF cycles is predictive of cycle outcome.Design, Patients The study was a prospective evaluation of 41 women beginning a GnRH-a-suppressed/hMG-stimulated IVF cycle.Setting The in vitro fertilization program of a tertiary care institution was the study setting.Main Outcome Measures The main outcome measures were (1) estradiol (E₂) and progesterone (P) levels on the day of human chorionic gonadotropin (hCG) administration and the following day and (2) the ovarian response to ovulation induction and clinical outcome.Results Ten of the 41 women achieved a clinical pregnancy (24.4%). There was no significant difference in progesterone (P) levels on the day of or the day following hCG administration between the pregnant and the nonpregnant groups. Both groups exhibited a significant rise in P level in response to hCG. There was no significant difference in E₂ levels on the day of hCG between the two groups. The serum E₂ did not rise significantly in response to hCG in either group. Patients who became pregnant had significantly more oocytes retrieved, fertilized, cleaved, and transferred.Conclusions Clinical response and outcome in GnRH-a-suppressed/hMG-stimulated IVF cycles are not predicted by early luteinizing potential as indicated by the response of E₂ or P to hCG.Presented at the 7th Annual World Congress of in Vitro Fertilization, Paris, France, June 30–July 3, 1991.     

Association of follicular fluid volume with membrane stretchability of human metaphase II oocytes following the gonadotropin‐releasing hormone agonist protocol during intracytoplasmic sperm injection

Purpose

The authors previously revealed the association of the follicular fluid (FF) volume with oolemma stretchability following the gonadotropin‐releasing hormone (GnRH) antagonist protocol during intracytoplasmic sperm injection (ICSI). However, the impact of the GnRH agonist protocol on oolemma stretchability remains unclear.

Methods

Data that were obtained from 74 ICSI cycles were reviewed retrospectively. Controlled ovarian stimulation was performed in accordance with the short GnRH agonist protocol. Each follicle was individually aspirated and assigned to one of six groups, according to the FF volume. The oolemma stretchability during ICSI was evaluated by using a mechanical stimulus for oolemma penetration; that is, oolemma penetration with or without aspiration (high vs low stretchability, respectively).

Results

The incidence of low oolemma stretchability was significantly higher in the <1.0 mL group than that in the ≥1.0 mL group. The normal fertilization rate was significantly lower in the <1.0 mL group than that in the 2.0‐<3.0 mL group. The rate of blastocyst development was lower in the <1.0 mL group than that in the 3.0‐<4.0 mL group.

Conclusion

The FF volume potentially was associated with metaphase II oolemma stretchability, fertilization, and blastocyst development.     

Rescue hCG to treat empty follicle syndrome after the use of a GnRH agonist as oocyte maturation trigger: First report on fresh embryo transfer and clinical pregnancy

We present a case series and literature review on the use of rescue human chorionic gonadotropin (hCG) in cases of empty follicle syndrome (EFS) after a gonadotropin-releasing hormone agonist (GnRHa) trigger. EFS was diagnosed after failure to collect any oocytes from one ovary. In such cases, a single dose of hCG was administered and the oocyte retrieval was repeated 36 h later. The main outcome measures were the number of mature oocytes (M2) and embryos (2PN), incidence of hospitalisation for severe ovarian hyperstimulation syndrome (OHSS) and clinical pregnancy when fresh embryo transfers occurred. Our population consisted of 322 patients, who had a GnRH agonist as oocyte maturation trigger (2-mg subcutaneous buserelin). Six patients (1.8%) developed EFS after the use of a GnRHa trigger. Mature oocytes were retrieved in 5 patients after the use of rescue hCG. One patient developed severe OHSS. Two patients had a fresh embryo transfer and one clinical pregnancy was reported. This is the first case series to report fresh embryo transfers and a clinical pregnancy with the use of rescue hCG after failure of the GnRHa trigger.     

Dexamethasone as an adjuvant therapy for anovulatory,normoandrogenic patients during ovulation induction with exogenous gonadotropins

Objective: The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy. Methods: The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded. Results: There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups. Conclusions: The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.     

Human chorionic gonadotropin assay in cervical secretions for accurate diagnosis of preterm labor.

OBJECTIVES: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. METHODS: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundred and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continuous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test. RESULTS: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery (r=-0.80, P<0.0001) was detected. The cut-off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were > or =32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were > or =32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; > or =30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; > or =33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally > or =27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks. CONCLUSIONS: Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.     

Delayed embryo implantation following in vitro fertilization and embryo transfer (IVFET)

Purpose: Our goal was to compare serum human chorionic gonadotropin (hCG) levels in singleton pregnancies achieved following IVFET with those achieved following spontaneous conception. Results: The mean serum hCG level of patients who became pregnant following IVFET lagged 1.5 days behind that of patients who became pregnant spontaneously. Conclusions: The use of gonadotropin releasing hormone analogue as part of the stimulation protocol leading to egg retrieval and IVFET results in a delay in embryo implantation.     

体外受精-胚胎移植中注射人绒毛膜促性腺激素后不同时间受精对早期胚胎发育及临床结局的影响

目的探讨人绒毛膜促性腺激素(h CG)注射后不同时间受精对体外受精-胚胎移植(IVF-ET)治疗患者实验室指标及临床指标的影响。方法选取行IVF-ET治疗并符合纳入标准的患者200例,根据h CG注射后受精时间不同随机分为4组:h CG注射后38.0~39.0 h受精为A组;注射h CG后39.1~40.0 h受精为B组、h CG注射后40.1~41.0 h受精为C组、h CG注射后41.1~42.0 h受精为D组,每组50例,观察并比较四组间实验室指标及临床指标。结果可用胚胎率B组(65.7%)、C组(63.3%)、D组(66.8%)均高于A组(55.5%)(P0.05);优质胚胎率A组(50.6%)显著低于C组(60.2%)与D组(63.6%)(P0.05),B组(54.3%)明显低于D组(P0.05);C组获得了较好的临床结局,临床妊娠率(50.0%)和着床率(34.2%)较高,流产率(9.1%)较低。正常受精率、正常卵裂率、临床妊娠率、着床率以及流产率组间比较,差异均无统计学意义(P0.05)。结论在一定时间范围内(38.0~42.0 h),随着h CG注射后受精时间的延长,优质胚胎率呈增高趋势;本中心IVF-ET治疗患者的最佳受精时间为h CG注射后40.1~41.0 h,此时受精患者有较高的临床妊娠率,较低的早期流产率及较好的临床妊娠结局。     

The time interval between hCG priming and oocyte retrieval in ART program: a meta-analysis

Objective  

To evaluate the relationship between different hCG priming-to-oocyte retrieval intervals and assisted reproductive technology (ART) outcome.