Human Chorionic Gonadotropin (hCG) is Effective at 5000 IU in ART

Objectives: Providers often elect to administer 5000 IU of hCG rather than 1000 IU as an LH surrogate during IVF in efforts to decrease ovarian hyperstimulation syndrome (OHSS) in high-risk patients. There are few studies which investigate whether a lower dose of hCG can reduce the incidence of OHSS without adversely effecting the clinical pregnancy (CPR) and implantation rates (IR). This study retrospectively examined outcomes between patients at risk for OHSS who received either 5000 or 10,000 IUs of hCG during ART.

Design: A retrospective chart review of 843 ART patients from January 1998 to December 1999 at a university-based ART center.

Materials and Methods: All patients with serum estradiol (E₂) >4000 pg/mL at the time of hCG administration were considered for analysis. The principle outcome variable was implantation rate. Secondary outcome variables were oocyte retrieved per patient, number of high grade embryos (HGE), CPR, IR, and total number of embryos cryopreserved. Patients hospitalized for OHSS were considered severe for this data set. Student’s t-test and Fisher’s exact were performed when appropriate.

Results: A total of 53 patients had serum E₂ >4000 pg/mL at the time of hCG administration; 30 patients received 10,000 IU and 23 received 5000 IU. Administration of 5000 or 10,000 IU of hCG was provider dependent, as some providers administered 5000 IU in efforts to decrease the risk of OHSS while others administered 10,000 IU to patients with higher follicle numbers. Significant differences were found in the E₂ concentrations at hCG and number of oocytes retrieved per patient (ORPP) between groups (∗p<0.05 for both).

Conclusion: There were no differences in pregnancy and cryopreservation rates between patients who received 5000 or 10,000 IUs of hCG. Oocyte retrieval rates per patient however, were significantly higher in the 10,000 IU group. Based on these data, it is likely that administration of 5000 IU of hCG to patients at high risk for OHSS is effective and does not alter outcome.

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Source: https://www.fertstert.org/article/S0015-0282(00)01407-2/fulltext