Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical pregnancy rates from in vitro fertilisation cycles: a prospective study

Alvaro Santibañez, Jorge García, Olga Pashkova, Omar Colín, Guillermo Castellanos, Ana P Sánchez, Julio F De la Jara, Alvaro Santibañez, Jorge García, Olga Pashkova, Omar Colín, Guillermo Castellanos, Ana P Sánchez, Julio F De la Jara

Abstract

Background: The implantation process after embryo transfer depends on the embryo quality and endometrial receptivity. It is estimated that fifty to seventy-five per cent of pregnancies are lost due to a failure of implantation. There is evidence that there is an early secretion of human chorionic gonadotrophin before embryo implantation, and this secretion has been linked to an important function in angiogenesis and the inflammatory response that promotes the implantation process. Our objective was to determine the effects of intrauterine injection of human chorionic gonadotropin (hCG) before the embryo transfer in an in vitro fertilisation cycle.

Methods: A prospective randomised study was conducted in Reproductive Medicine Centre PROCREA in Mexico City. Infertile patients who had a medical indication for in vitro fertilisation were studied. Two groups were included (n 210); the intervention group received an intrauterine injection of 500 IU of hCG before the embryo transfer (n 101). The control group (n 109) did not receive hCG. Comparisons were performed using a chi-square test.

Results: The clinical pregnancy rate (CPR) was our principal outcome. The implantation rate was a secondary outcome. The implantation rate was significantly higher in the hCG group compared to the control group (52.4% vs 35.7%, p 0.014). The clinical pregnancy rate was also significantly higher (50.4 vs 33.0%, p 0.010). No adverse effects were observed.

Conclusions: The intrauterine injection of hCG before embryo transfer showed a significant increase in the clinical pregnancy rate. More clinical trials are needed to reproduce these results on this promising intervention. The live birth rate must be included in subsequent studies.

References

    1. te Velde ER, Eijkemans R, Habbema HD. Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet. 2000;355:1928–1929. doi: 10.1016/S0140-6736(00)02320-5.
    1. Kably Ambe A, López Ortiz CS, Serviere Zaragoza C, Velázquez Cornejo G, Pérez Peña E, Santos Haliscack R, Luna Rojas M, Valerio E, Santana H, Gaviño Gaviño F. Consenso nacional Mexicano de reproducción asistida. Ginecol Obstet Mex. 2012;80:581–624.
    1. Society for assisted reproductive technology national data summary. .
    1. Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy. N Engl J Med. 2001;345:1400–1408. doi: 10.1056/NEJMra000763.
    1. Bonduelle ML, Dodd R, Liebaers I, Van Steirteghem A, Williamson R, Akhurst R. Chorionic gonadotrophin-beta mRNA, a trophoblast marker, is expressed in human 8-cell embryos derived from tripronucleate zygotes. Hum Reprod. 1988;3:909–914.
    1. Lopata A, Hay DL. The potential of early human embryos to form blastocysts, hatch from their zona and secrete HCG in culture. Hum Reprod. 1989;4:87–94. doi: 10.1093/humrep/4.suppl_1.87.
    1. Reinisch N, Sitte BA, Kähler CM, Wiedermann CJ. Human chorionic gonadotrophin: a chemoattractant for human blood monocytes, neutrophils and lymphocytes. J Endocrinol. 1994;142:167–170. doi: 10.1677/joe.0.1420167.
    1. Bourdiec A, Bédard D, Rao CV, Akoum A. Human chorionic gonadotropin regulates endothelial cell responsiveness to interleukin 1 and amplifies the cytokine-mediated effect on cell proliferation, migration and the release of angiogenic factors. Am J Reprod Immunol. 2013. published online ahead of print Jan 28, 2013.
    1. Bourdiec A, Shao R, Rao CV, Akoum A. Human chorionic gonadotropin triggers angiogenesis via the modulation of endometrial stromal cell responsiveness to interleukin 1: a new possible mechanism underlying embryo implantation. Biol Reprod. 2012;87(3):1–10. 66.
    1. Berndt S, Blacher S, Munaut C, Detilleux J, Perrier D’Hauterive S, Huhtaniemi I, Evain-Brion D, Noël A, Fournier T, Foidart JM. Hyperglycosylated human chorionic gonadotropin stimulates angiogenesis through TGF-β receptor activation. FASEB J. 2013;27(4):1309–1321. doi: 10.1096/fj.12-213686.
    1. Palomino WA, Argandoña F, Azúa R, Kohen P, Devoto L. Complement C3 and decay-accelerating factor expression levels are modulated by human chorionic gonadotropin in endometrial compartments during the implantation window. Reprod Sci. 2013. published online ahead of print Feb 20, 2013.
    1. Licht P, Fluhr H, Neuwinger J, Wallwiener D, Wildt L. Is human chorionic gonadotropin directly involved in the regulation of human implantation? Mol Cell Endocrinol. 2007;269:85–92. doi: 10.1016/j.mce.2006.09.016.
    1. Xiao-Yan C, Jie L, Dang J, Tao L, Xin-Ru L, Guang-Lun Z. A highly sensitive electrochemiluminescence immunoassay for detecting human embryonic human chorionic gonadotropin in spent embryo culture media during IVF-ET cycle. J Assist Reprod Genet. 2013;30(3):377–382. doi: 10.1007/s10815-012-9923-7.
    1. Mansour R, Tawab N, Kamal O, El-Faissal Y, Serour A, Aboulghar M, Serour G. 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(6):1370–1374. doi: 10.1016/j.fertnstert.2011.09.044.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe