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Hum. Reprod. Advance Access originally published online on July 17, 2009
Human Reproduction 2009 24(11):2910-2916; doi:10.1093/humrep/dep253
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study

C. Blockeel1,3, M. De Vos1, W. Verpoest1, D. Stoop1, P. Haentjens2 and P. Devroey1

1 Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium 2 Centre for Outcomes Research and Laboratory for Experimental Surgery, UZ Brussel, Brussels, Belgium

3 Correspondence address. E-mail: christophe.blockeel{at}uzbrussel.be

BACKGROUND: GnRH-antagonist protocols shorten the treatment period and reduce inconvenience for IVF patients. This randomised controlled trial (RCT) further explored whether low-dose hCG can be used clinically to replace recombinant FSH (rFSH) during the late follicular phase in a GnRH-antagonist protocol.

METHODS: Seventy ICSI patients undergoing controlled ovarian stimulation (COS) in a GnRH-antagonist protocol was randomized into two groups. The control group received a standard treatment with rFSH (Puregon) plus a GnRH-antagonist, daily from Day 6 of stimulation. In the study group, rFSH was discontinued when six follicles ≥12 mm were observed and estradiol levels were >600 ng/l; rFSH was subsequently replaced by low-dose hCG (200 IU/l daily).

RESULTS: Mean values (SD) for dose and duration of rFSH treatment in the control versus low-dose hCG group were 1617 (280) versus 1273 (260) IU rFSH [between-group difference –344, 95% confidence interval (CI) –483 to –205; P < 0.001], and 8.2 (1.6) versus 6.4 (1.3) days (–1.8, –2.6 to –1.1; P < 0.001), respectively. The mean number of metaphase II oocytes of 10.1 versus 8.9 (between-group difference –1.2, 95% CI –3.9 to 1.5) and the ongoing pregnancy rates of 10/35 (29%) versus 13/35 (37%) (between-group difference 8.6%; 95% CI –13.0 to 29.1%; P = 0.45) for control versus hCG, respectively, did not differ.

CONCLUSION: In this pilot trial, substitution of rFSH by low-dose hCG in the final days of COS leads to a reduction of FSH consumption whereas ICSI outcome, in terms of oocyte yield and ongoing pregnancy rate, remains comparable to the traditional regimen (ClinicalTrials.gov, trial number: NCT00750100 [ClinicalTrials.gov] ).

Key words: hCG/recombinant FSH/GnRH antagonist cycle/ICSI/ongoing pregnancy rate

Submitted on December 16, 2009; resubmitted on April 1, 2009; accepted on May 20, 2009.


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