NEW YORK (Reuters Health) – Using human chorionic gonadotropin (hCG) for follicular phase stimulation didn’t have much of an effect on assisted reproduction outcomes in a meta-analysis by Spanish researchers.
But while adding hCG during controlled ovarian hyperstimulation does not increase pregnancy rates, “it reduces the dose of exogenous FSH (follicle stimulating hormone) required, the cost of which is greater than hCG,” Dr. Miguel A. Checa told Reuters Health by email.
The overall quality of the evidence was low, however, and the heterogeneity of treatments in the different studies “makes the overall interpretation of data difficult,” said Dr. Checa, of the Universitat Autonoma de Barcelona, and his colleagues in their report online April 1 in Fertility and Sterility.
The researchers ultimately examined outcomes of 1,068 women in 11 randomized controlled trials comparing hCG to other hormone treatments, placebo, or no administration during follicular stimulation.
They considered the use of hCG in two specific situations: ovarian priming before the use of FSH at the beginning of the cycle, and in the late follicular phase at the time of the appearance of luteinizing hormone (LH) receptors.
Whether hCG was given early or late, there was no difference in rates of live birth, miscarriage, or ovarian hyperstimulation syndrome.
Pooled analysis for clinical pregnancy showed significant differences in favor of hCG at the late follicular phase. But according to Dr. Checa, the heterogeneity of the trials and the small number of such events “means that the confidence in increasing pregnancy is weak.”
Still, FSH doses were lower in women treated with hCG. “Both hCG and FSH protocols for follicular stimulation are equally effective and safe,” the researchers conclude, “but the low cost of hCG stimulation makes this alternative more efficient.”
Fertil Steril 2012.