Abstract
Objective
To investigate whether intrauterine perfusion of hCG before embryo transfer (ET) is
effective in women experienced two or more implantation failures.
Study design
Systematic review and meta-analysis. In the current meta-analysis, Pubmed, EMBASE
and The Cochrane Library were searched for trials which compared the efficacy of intrauterine
perfusion of hCG with no perfusion of hCG in women undergoing in vitro fertilization
(IVF), intracytoplasmic sperm injection (ICSI), or frozen embryo transfer (FET) before
ET. The primary outcomes are the clinical pregnancy rate (CPR) and live birth rate
(LBR).
Results
Six trials consisted of 1432 women were eligible for quantitative analysis. CPR (including
6 trials consisted of 1432 women) and LBR (including 3 trials consisted of 870 women)
were significantly improved in the hCG group compared to the control group, with a
CPR of 41.8 % vs. 31.2 % (RR 1.30, 95 % CI 1.14∼1.50, P < .001), an LBR of 27.8 % vs. 18.0 % (RR 1.52, 95 % CI 1.18∼1.96, P = .001).
Conclusion
Intrauterine perfusion of hCG is effective in improving clinical pregnancy rate and
live birth rate in women who experienced two or more implantation failures, which
might provide a potential therapeutical intervention for recurrent implantation failure
(RIF). Although promising, further evidence from multicenter, randomized controlled
trials are needed to confirm the conclusion from the current meta-analysis.
Abbreviations:
HCG (human chorionic gonadotropin), IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection), FET (frozen embryo transfer), ET (embryo transfer), CPR (clinical pregnancy rate), LBR (live birth rate), RR (risk ratio), CI (confidence index), RIF (recurrent implantation failure), ART (assisted reproductive technology)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Influence of controlled ovarian hyperstimulation on uterine peristalsis in infertile women.Hum Reprod. 2012; 27: 2684-2689
- The relationship between cell number, division behavior and developmental potential of cleavage stage human embryos: a time-lapse study.PLoS One. 2016; 11e0153697
- Variability in the expression of trophectodermal markers beta-human chorionic gonadotrophin, human leukocyte antigen-G and pregnancy specific beta-1 glycoprotein by the human blastocyst.Hum Reprod. 1999; 14: 1852-1858
- Chorionic gonadotrophin-beta mRNA, a trophoblast marker, is expressed in human 8-cell embryos derived from tripronucleate zygotes.Hum Reprod. 1988; 3: 909-914
- The potential of early human embryos to form blastocysts, hatch from their zona and secrete HCG in culture.Hum Reprod. 1989; 4: 87-94
- Linkage of human chorionic gonadotrophin and placental lactogen biosynthesis to trophoblast differentiation and tumorigenesis.Placenta. 1985; 6: 163-172
- New discoveries on the biology and detection of human chorionic gonadotropin.Reprod Biol Endocrinol. 2009; 7
- Molecular aspects of direct LH/hCG effects on human endometrium--lessons from intrauterine microdialysis in the human female in vivo.Reprod Biol. 2001; 1: 10-19
- Epithelial human chorionic gonadotropin is expressed and produced in human secretory endometrium during the normal menstrual cycle.Biol Reprod. 2009; 80: 1053-1065
- Treatment of human endometrial stromal cells with chorionic gonadotropin promotes their morphological and functional differentiation into decidua.Mol Cell Endocrinol. 1999; 147: 7-16
- Intrauterine human chorionic gonadotropin infusion in oocyte donors promotes endometrial synchrony and induction of early decidual markers for stromal survival: a randomized clinical trial.Hum Reprod. 2016; 31: 1552-1561
- Intrauterine HCG infusion affects the distribution of natural killer cells in the endometrium of fertile oocyte donors.Fertil Steril. 2015; 104: e149-e150
- Endocrine factors modulating immune responses in pregnancy.Front Immunol. 2014; 5: 196
- The role of HCG in implantation: a mini-review of molecular and clinical evidence.Int J Mol Sci. 2017; 18
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- The Cochrane Collaboration Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011 (-2011 (- 14))
- Intrauterine injection of human chorionic gonadotropin before embryo transfer may improve the pregnancy rates in in vitro fertilization cycles of patients with repeated implantation failures.in: Proceedings of the 5th IVI International Congress, 2013 Apr 4-6; Seille, Spain2013
- Intra-uterine administration of human chorionic gonadotrophin (HCG) before embryo transfer in recurrent implantation failure (RIF) patients improves implantation and pregnancy rates in IVF-ICSI cycles.Hum Reprod. 2014; 29: i79
- A study of intrauterine infusion of human chorionic gonadotropin (hCG) before frozen-thawed embryo transfer after two or more implantation failures.Gynecol Endocrinol. 2017; 33: 67-69
- Effects of intrauterine perfusion of human chorionic gonadotropin in women with different implantation failure numbers.Am J Reprod Immunol. 2018; 79
- Should intrauterine human chorionic gonadotropin infusions ever be used prior to embryo transfer?.J Assist Reprod Genet. 2018; 35: 273-278
- Intrauterine administration of human chorionic gonadotropin improves the live birth rates of patients with repeated implantation failure in frozen-thawed blastocyst transfer cycles by increasing the percentage of peripheral regulatory T cells.Arch Gynecol Obstet. 2019;
- Novel role of human chorionic gonadotropin in differentiation of human cytotrophoblasts.Endocrinology. 1993; 132: 1387-1395
- Hyperglycosylated hCG: a Unique Human Implantation and Invasion Factor.Am J Reprod Immunol. 2016; 75: 333-340
- HCG in the regulation of placental angiogenesis. Results of an in vitro study.Placenta. 2007; 28: S85-93
- On the role of human chorionic gonadotropin (hCG) in the embryo-endometrial microenvironment: implications for differentiation and implantation.Semin Reprod Med. 2001; 19: 37-47
- Human chorionic gonadotropin confers resistance to oxidative stress-induced apoptosis in decidualizing human endometrial stromal cells.Fertil Steril. 2011; 95: 1302-1307
- Human chorionic gonadotropin attracts regulatory T cells into the fetal-maternal interface during early human pregnancy.J Immunol. 2009; 182: 5488-5497
- Human chorionic gonadotropin potentially affects pregnancy outcome in women with recurrent implantation failure by regulating the homing preference of regulatory T cells.Am J Reprod Immunol. 2017; 77
- The effect of trophoblasts on T lymphocytes: possible regulatory effector molecules--a proteomic analysis.Cell Physiol Biochem. 2008; 21: 463-472
- Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction.Cochrane Database Syst Rev. 2018; 10Cd011537
- A proteome approach reveals differences between fertile women and patients with repeated implantation failure on endometrial level(-)does hCG render the endometrium of Rif patients?.Int J Mol Sci. 2019; 20
Article info
Publication history
Published online: October 28, 2019
Accepted:
October 23,
2019
Received in revised form:
October 21,
2019
Received:
July 22,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
