Investigation of luteal HCG supplementation in GnRH-agonist-triggered fresh embryo transfer cycles: a randomized controlled trial

Louise Svenstrup; Sören Möller; Jens Fedder; Dorrit Elschner Pedersen; Karin Erb; Claus Yding Andersen; Peter Humaidan

doi:10.1016/j.rbmo.2023.103415

Investigation of luteal HCG supplementation in GnRH-agonist-triggered fresh embryo transfer cycles: a randomized controlled trial

Reprod Biomed Online. 2023 Sep 16;48(5):103415. doi: 10.1016/j.rbmo.2023.103415. Online ahead of print.

Authors

Louise Svenstrup¹, Sören Möller², Jens Fedder³, Dorrit Elschner Pedersen⁴, Karin Erb⁴, Claus Yding Andersen⁵, Peter Humaidan⁶

Affiliations

¹ Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark; Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark. Electronic address: louise.svenstrup@rsyd.dk.
² Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
³ Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Research Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark; Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
⁴ Fertility Clinic, Unit of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
⁵ Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁶ Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Faculty of Health, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.

PMID: 38452605
DOI: 10.1016/j.rbmo.2023.103415

Abstract

Research question: Does splitting the human chorionic gonadotrophin (HCG) support in IVF cycles triggered by a gonadotrophin-releasing hormone agonist result in a better progesterone profile?

Design: Randomized controlled three-arm study, performed at the Fertility Clinic, Odense University Hospital, Denmark. Patients with 12-25 follicles ≥12 mm were randomized into three groups: Group 1 - ovulation triggered with 6500 IU HCG; Group 2 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1500 IU HCG on the day of oocyte retrieval (OCR); and Group 3 - ovulation triggered with 0.5 mg GnRH agonist, followed by 1000 IU HCG on the day of OCR and 500 IU HCG on OCR + 5. All groups received 180 mg vaginal progesterone. Progesterone concentrations were analysed in eight blood samples from each patient.

Results: Sixty-nine patients completed the study. Baseline and laboratory data were comparable. Progesterone concentration peaked on OCR + 4 in Groups 1 and 2, and peaked on OCR + 6 in Group 3. On OCR + 6, the progesterone concentration in Group 2 was significantly lower compared with Groups 1 and 3 (P = 0.003 and P < 0.001, respectively). On OCR + 8, the progesterone concentration in Group 3 was significantly higher compared with the other groups (both P<0.001). Progesterone concentrations were significantly higher in Group 3 from OCR + 6 until OCR + 14 compared with the other groups (all P ≤ 0.003). Four patients developed ovarian hyperstimulation syndrome in Group 3.

Conclusion: Sequential HCG support after a GnRH agonist trigger provides a better progesterone concentration in the luteal phase.

Keywords: Corpus luteum; GnRH agonist trigger; HCG; IVF; Luteal phase; Progesterone.