INTRAUTERINE HCG INJECTION BEFORE FROZEN EMBRYO TRANSFER IN PATIENTS WITH PREVIOUS FRESH EMBRYO TRANSFER FAILURE: A RANDOMIZED CONTROLLED STUDY
Menna M. Saad, Fouad A. Abu Hemila, Adel M. Atef, Noura El-Nassery
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
Purpose: Successful blastocyst implantation requires embryo-endometrium synchrony. Frozen embryo transfer (FET) is one approach to avoid asynchrony. Intrauterine administration of human chorionic gonadotropin (hCG) was proposed to enhance embryo implantation. This study assessed the effect of the intrauterine hCG injection in two doses before FET in cases of repeated implantation failure. Methods: This prospective randomized controlled clinical trial included participants scheduled for FET after at least one previous failed fresh ET. They were randomly divided into two groups; the Injection Group and the Control Group. Then, the Injection Group was further randomized into two subgroups, G500 and G1000, to receive intrauterine hCG 500 IU, or 1000 IU, respectively. The primary outcome measure was the clinical pregnancy rate, and secondary outcomes were the chemical pregnancy rate and modifiers of clinical pregnancy. Results: The final analysis included 225 women, 112 in the control group, 57 in the G500 Group, and 56 in the G1000 Group. The chemical and clinical pregnancy rates were significantly higher in patients receiving 1000 IU of hCG than those receiving 500 IU units and the control group (p= 0.008 and p=0.006, respectively). Post-hoc tests showed that the G1000 Group had significantly higher rates than the Control and G500 Groups. Age, BMI, AMH, endometrial thickness, and the number of transferred embryos did not affect pregnancy outcomes. Conclusion: Intrauterine administration of 1000 IU hCG before FET increases the pregnancy rate in women with previous failed fresh ET.