Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 10 , ISSUE 1 ( January-March, 2018 ) > List of Articles


Evaluation of the Impact of 1,000-unit Intrauterine Injection of Human Chorionic Gonadotropin prior to in vitro Fertilization on Success Rate of Implantation in Infertile Women: A Double-blind Randomized Trial

Masomeh Rezaei, Friba Frhadifar, Ghobad Moradi, Ilnaz Khalatbari

Keywords : Clinical trial, Human chorionic gonadotropin, In vitro fertilization, Intrauterine, Successful implantation

Citation Information : Rezaei M, Frhadifar F, Moradi G, Khalatbari I. Evaluation of the Impact of 1,000-unit Intrauterine Injection of Human Chorionic Gonadotropin prior to in vitro Fertilization on Success Rate of Implantation in Infertile Women: A Double-blind Randomized Trial. J South Asian Feder Obs Gynae 2018; 10 (1):10-14.

DOI: 10.5005/jp-journals-10006-1550

Published Online: 01-02-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Aim: Studies have shown that intrauterine injection of human chorionic gonadotropin (hCG) prior to embryo transfer causes success in pregnancy. This study has been done to determine the effect of 1,000-unit intrauterine injection of hCG prior to in vitro fertilization (IVF) on success rate of implantation in infertile women. Materials and methods: This double-blind clinical trial study has been done on two intervention groups (n = 40) and control group (n = 40), who were randomly selected. For the intervention group cases, soft catheter penetrated the uterus and 0.3 cc of liquid fetus culture media with 0.2 cc (1000 unit) of hCG was injected into the uterus. After 7 minutes, the fetus was transferred into the uterus with a soft catheter. In the control group, 0.5 cc of liquid fetus culture media was injected into the uterus and after 7 minutes embryo was transferred into the uterus with another soft catheter. In both groups, the speculum was removed after 3 minutes. Results: The results of this study showed that pregnancy success was the same in both intervention and control groups and it was in eight cases (20%). In this study, 38 cases (95%) of the agonistic cycle type were in the intervention group and 33 (82.5%) cases were in the control group (p > 0.05). On assessment of the situation of pregnancy of each person according to the ultrasound results, the size of right and left ovary in two groups showed no significant differences (p > 0.05). Conclusion: The pregnancy success during the IVF process is related to the quality of the blastocyst in the secretion of many cytokines and hormones in the early days of egg cell implantation, such as interleukin 1 and hCG, and increased level of these hormones and mediators causes disruption of the process of making proteins needed for implantation at the start of the initial development.

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  1. Santibanez A, Garcia J, Pashkova O, Colin O, Castellanos G, Sanchez AP, De la Jara JF. Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical pregnancy rates from in vitro fertilisation cycles: a prospective study. Reprod Biol Endocrinol 2014;12:9.
  2. Nanbakhsh F, Ilkhanizadeh B, Moghadasian Niaki N, Oshnouei S, Mazloomi P. Clinical results of microinjection with long protocol and prednisolone addition. Tehran Univ Med J TUMS Publications 2015 Apr;73(1):31-39.
  3. Margalioth EJ, Ben-Chetrit A, Gal M, Eldar-Geva T. Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod 2006 Dec;21(12):3036-3043.
  4. Ahonen P, Miettinen A, Perheentupa J. Adrenal and steroidal cell antibodies in patients with autoimmune polyglandular disease type I and risk of adrenocortical and ovarian failure. J Clin Endocrinol Metab 1987 Mar;64(3):494-500.
  5. Anasti JN. Premature ovarian failure: an update. Fertil Steril 1998 Jul;70(1):1-15.
  6. Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy. N Engl J Med 2001 Nov;345(19): 1400-14008.
  7. Hosseini RS, Farzadi L, Abdollahi S, Nouri M, Ghasemzadeh A, Hamdi K, Soleimanpour H. Effect of intrauterine injection of human chorionic gonadotropin before frozen-thawed embryo transfer on implantation and clinical pregnancy rate: a randomized controlled trial. Int J Womens Health Reprod Sci 2016 Oct;4(4):189-193.
  8. 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 (Oxford, England) 1988 Oct;3(7):909-914.
  9. 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 Nov;4(8 Suppl):87-94.
  10. 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 Dec;96(6):1370-1374.e1.
  11. Aaleyasin A, Aghahosseini M, Rashidi M, Safdarian L, Sarvi F, Najmi Z, Mobasseri A, Amoozgar B. In vitro fertilization outcome following embryo transfer with or without preinstillation of human chorionic gonadotropin into the uterine cavity: a randomized controlled trial. Gynecol Obstet Invest 2015;79(3):201-205.
  12. Hong KH, Forman EJ, Werner MD, Upham KM, Gumeny CL, Winslow AD, Kim TJ, Scott RT Jr. Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, placebo-controlled trial. Fertil Steril 2014 Dec;102(6):1591-1595.e2.
  13. Zarei A, Parsanezhad ME, Younesi M, Alborzi S, Zolghadri J, Samsami A, Amooee S, Aramesh S. Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: A randomized clinical trial. Iranian J Reprod Med 2014 Jan;12(1):1-6.
  14. Sanfins A, Plancha CE, Overstrom EW, Albertini DF. Meiotic spindle morphogenesis in in vivo and in vitro matured mouse oocytes: insights into the relationship between nuclear and cytoplasmic quality. Hum Reprod (Oxford, England) 2004 Dec;19(12):2889-2899.
  15. Bourdiec A, Bedard 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 (New York, NY: 1989) 2013 Aug;70(2):127-138.
  16. 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 Sep;87(3):66.
  17. 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-beta receptor activation. FASEB J 2013 Apr;27(4):1309-1321.
  18. Palomino WA, Argandona F, Azua 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 (Thousand Oaks, Calif) 2013 Sep;20(9): 1103-1110.
  19. 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 Apr;269(1-2):85-92.
  20. Torabizadeh A, Mirzaiian S. Comparison of results of IVF with three protocols ovulation induction in infertile women with polycystic ovary syndrome. J Obstet Gynecol Infertil 1390;14(1):7-13.
  21. Wirleitner B, Schuff M, Vanderzwalmen P, Stecher A, Okhowat J, Hradecky L, Kohoutek T, Králícková M, Spitzer D, Zech NH. Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study. Reprod Biol Endocrinol 2015 Jul;13:70.
  22. Wan H, Versnel MA, Cheung WY, Leenen PJ, Khan NA, Benner R, Kiekens RC. Chorionic gonadotropin can enhance innate immunity by stimulating macrophage function. J Leukoc Biol 2007 Oct;82(4):926-933.
  23. Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss JF, Petraglia F. Inflammation and pregnancy. Reprod Sci 2009; 16(2):206-15.
  24. Schumacher A, Brachwitz N, Sohr S, Engeland K, Langwisch S, Dolaptchieva M, Alexander T, Taran A, Malfertheiner SF, Costa SD, et al. Human chorionic gonadotropin attracts regulatory T cells into the fetal-maternal interface during early human pregnancy. J Immunol 2009 May;182(9):5488-5497.
  25. Zenclussen AC, Gerlof K, Zenclussen ML, Ritschel S, Zambon Bertoja A, Fest S, Hontsu S, Ueha S, Matsushima K, Leber J, et al. Regulatory T cells induce a privileged tolerant microenvironment at the fetal-maternal interface. Eur J Immunol 2006 Jan;36(1):82-94.
  26. Dokras A, Sargent IL, Barlow DH. Human blastocyst grading: an indicator of developmental potential? Hum Reprod (Oxford, England) 1993 Dec;8(12):2119-2127.
  27. Woodward BJ, Lenton EA, Turner K. Human chorionic gonadotrophin: embryonic secretion is a time-dependent phenomenon. Hum Reprod (Oxford, England) 1993 Sep;8(9):1463-1468.
  28. Butler SA, Luttoo J, Freire MO, Abban TK, Borrelli PT, Iles RK. Human chorionic gonadotropin (hCG) in the secretome of cultured embryos: hyperglycosylated hCG and hCG-free beta subunit are potential markers for infertility management and treatment. Reprod Sci (Thousand Oaks, Calif) 2013 Sep;20(9):1038-1045.
  29. 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 Mar;30(3):377-382.
  30. Wang H, Zhang R, Han D, Liu C, Cai J, Bi Y, Wen A, Quan S. Association of human chorionic gonadotropin level in embryo culture media with early embryo development. Nan Fang Yi Ke Da Xue Xue Bao 2014 Jun;34(7):1039-1041, 1047.
  31. Thompson SM, Onwubalili N, Brown K, Jindal SK, McGovern PG. Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer (eSET): a national study. J Assist Reprod Genet 2013 Dec;30(12):1577-1581.
  32. Ahlstrom A, Westin C, Reismer E, Wikland M, Hardarson T. Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer. Hum Reprod (Oxford, England) 2011 Dec;26(12):3289-3296.
  33. Moradan S. Assessment of the relationship between endometrial thickness and number of dominant follicles in pregnancy rate among 361 intrauterine insemination cases. Koomesh 2008;9(3):217-221.
  34. Baharara J, Moosavifar N, Jalali M, Adl F. The effect of HCG on in vitro maturation of human immature oocytes and rate of 8 cell embryos mediated by ICSI. Armaghane Danesh. 2008;12(4):55-64.
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