ABSTRACT Context: Optimal timing of hCG administration is a crucial step for successful IVF. Currently used standard hCG administration timing is not always practically possible due to weekends break or other reasons. Sometimes hCG needs to be administrated earlier or later than standard timing. Aim: To find out whether earlier or later hCG administration gives better IVF outcome. Setting and Design: A retrospective study on patients who underwent conventional IVF treatment. Methods and Material: Based on hCG timing, the patients were divided into three groups: the early hCG group where the hCG was given when less than three follicles ≥ 17 mm; the standard hCG group where the hCG was given when three or more follicles ≥ 17 mm; and the late hCG group where the hCG was given 1 to 3 days after the standard timing. The number of retrieved mature oocytes, the fertilization rate, the number of good quality embryos, the pregnancy rate and the live birth rate were compared among three groups. Statistical Analysis: x2 test, fisher exact test and Student t-test were used. Results: in total, 289 patients, 305 IVF cycles and 2784 oocytes were analyzed. The late hCG group has significantly larger number of MII oocytes, fertilized oocytes and good quality embryos per IVF cycle, when compared with the early hCG group. The fertilization rate, the pregnancy rate and the live birth rate per IVF cycle were similar among the three groups. Conclusion: Although the delayed administration of hCG did not favor IVF outcome per IVF cycle, the cumulative pregnancy rate is likely to be improved with consideration of higher yield of good quality embryos.
Cite this paper
Zhang, P. and Wånggren, K. (2012) Late hCG administration yields more good quality embryos and favors the overall IVF outcome. Open Journal of Obstetrics and Gynecology, 2, 331-336. doi: 10.4236/ojog.2012.24070.
 Chuang, M., Zapantis, A., Taylor, M., Jindal, S.K., Neal-Perry, G.S., Lieman, H.J. and Polotsky, A.J. (2010) Prolonged gonadotropin stimulation is associated with decreased ART success. Journal of Assisted Reproduction and Genetics, 27, 711-717.
 Dimitry, E.S., Oskarsson, T., Conaghan, J., Margara, R. and Winston, R.M. (1991) Beneficial effects of a 24 h delay in human chorionic gonadotrophin administration during in-vitro fertilization treatment cycles. Human Reproduction, 6, 944-946.
 Kolibianakis, E.M., Albano, C., Camus, M., Tournaye, H., Van Steirteghem, A.C. and Devroey, P. (2004) Prolongation of the follicular phase in in-vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertility and Sterility, 82, 102-107.
 Kolibianakis, E.M., Bourgain, C., Papanikolaou, E.G., Camus, M., Tournaye, H., Van Steirteghem, A.C. and Devroey, P. (2005) Prolongation of follicular phase by delaying hCG administration results in a higher incidence of endometrial advancement on the day of oocyte retrieval in GnRH antagonist cycles. Human Reproduction, 20, 2453-2456. doi:10.1093/humrep/dei069
 Tan, S.L., Balen, A., El Hussein, E., Mills, C., Campbell, S., Yovich, J. and Jacobs, H.S. (1992) A prospective randomized study of the optimum timing of human chorionic gonadotropin administration after pituitary desensitization in in-vitro fertilization. Fertility and Sterility, 57, 1259-1264.
 Tremellen, K.P. and Lane, M. (2010) Avoidance of weekend oocyte retrievals during GnRH antagonist treatment by simple advancement or delay of hCG administration does not adversely affect IVF live birth outcomes. Human Reproduction, 25, 1219-1224.
 Kilicdag, E.B., Haydardedeoglu, B., Cok, T., Hacivelioglu, S.O. and Bagis, T. (2010) Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles. Archives of Gynecology and Obstetrics, 281, 747-752.
 Bosch, E., Labarta, E., Crespo, J., Simon, C., Remohi, J., Jenkins, J. and Pellicer, A. (2010) Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: Analysis of over 4000 cycles. Human Reproduction, 25, 2092-2100. doi:10.1093/humrep/deq125
 Bergh, C., Broden, H., Lundin, K. and Hamberger, L. (1998) Comparison of fertilization, cleavage and pregnancy rates of oocytes from large and small follicles. Human Reproduction, 13, 1912-1915.
 Padhy, N., Latha, M., Sathya, B. and Varma, T.R. (2009) Antral follicle size in the downregulated cycle and its relation to in vitro fertilization outcome. Journal of Human Reproductive Sciences, 2, 68-71.
 Rosen, M.P., Shen, S., Dobson, A.T., Rinaudo, P.F., McCulloch, C.E. and Cedars, M.I. (2008) A quantitative assessment of follicle size on oocyte developmental competence. Fertility and Sterility, 90, 684-690.
 Saith, R.R., Srinivasan, A., Michie, D. and Sargent, I.L. (1998) Relationships between the developmental potential of human in-vitro fertilization embryos and features describing the embryo, oocyte and follicle. Human Reproduction Update, 4, 121-134.
 Dubey, A.K., Wang, H.A., Duffy, P. and Penzias, A.S. (1995) The correlation between follicular measurements, oocyte morphology, and fertilization rates in an in vitro fertilization program. Fertility and Sterility, 64, 787-790.
 Miller, K.F., Goldberg, J.M. and Falcone, T. (1996) Follicle size and implantation of embryos from in vitro fertilization. Obstetrics & Gynecology, 88, 583-586.
 Wittmaack, F.M., Kreger, D.O., Blasco, L., Tureck, R.W., Mastroianni, L., Jr. and Lessey, B.A. (1994) Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: A 6-year data collection. Fertility and Sterility, 62, 1205-1210.
 Andersen, C.Y. (1993) Characteristics of human follicular fluid associated with successful conception after in vitro fertilization. Journal of Clinical Endocrinology & Metabolism, 77, 1227-1234. doi:10.1210/jc.77.5.1227
 Shmorgun, D., Hughes, E., Mohide, P. and Roberts, R. (2010) Prospective cohort study of three-versus two-dimensional ultrasound for prediction of oocyte maturity. Fertility and Sterility, 93, 1333-1337.
 Baltz, J.M. and Tartia, A.P. (2010) Cell volume regulation in oocytes and early embryos: Connecting physiology to successful culture media. Human Reproduction Update, 16, 166-176. doi:10.1093/humupd/dmp045
 Daya, S. (2000) Gonadotropin releasing hormone agonist protocols for pituitary desensitization in in vitro fertilization and gamete intrafallopian transfer cycles. Cochrane Database of Systematic Reviews, 1, CD001299.
 Muasher, S.J., Abdallah, R.T. and Hubayter, Z.R. (2006) Optimal stimulation protocols for in vitro fertilization. Fertility and Sterility, 86, 267-273.
 Bodri, D., Sunkara, S.K. and Coomarasamy, A. (2011) Gonadotropin-releasing hormone agonists versus antagonists for controlled ovarian hyperstimulation in oocyte donors: A systematic review and meta-analysis. Fertility and Sterility, 95, 164-169.
 Devroey, P., Aboulghar, M., Garcia-Velasco, J., Griesinger, G., Humaidan, P., Kolibianakis, E., Ledger, W., Tomas, C. and Fauser, B.C. (2009) Improving the patient’s experience of IVF/ICSI: a proposal for an ovarian stimulation protocol with GnRH antagonist co-treatment. Human Reproduction, 24, 764-774. doi:10.1093/humrep/den468