EC Gynaecology

Background: Early technology in recombinant hCG (r-hCG) production initially focused on manufacturing biological molecules in bacterial cells, typically Escherichia coli. Subsequently, these molecules were produced by introducing genetic material into non-human cell lines (Chinese hamster ovary cells) capable of replicating identical amino acid sequences to the human compound. Recombinant hCG (rhCG) has recently emerged as an alternative to urinary hCG for the final maturation of oocytes in women undergoing IVF and ICSI treatments. rhCG is derived from genetically engineered Chinese hamster ovary cells using recombinant DNA technology.

It is evident these days that recombinant hCG (r-hCG) is well tolerated and offers remarkable consistency from batch to batch, high purity, and high specific activity. However, there is no consensus regarding the dose and the form of HCG that should be utilized.

Design and Methods: This is a retrospective, single-center study conducted at the British-Syrian IVF and Fetal Medicine Centre, AL Rasheed Hospital, Syria.

The study initially included 356 women who underwent the ICSI procedure with the GnRH Antagonist protocol due to various subfertility factors. The women were divided into 2 groups: Group 1, who received 500 mcg (Ovitrelle) of rhCG as an oocyte maturation trigger, and group 2, who received a combination of 250 mcg rhCG (Ovitrelle) plus 5000 IU uhCG (Hucog).

No special considerations were taken for distributing the two groups regarding the administration of ovulation-triggering drugs. However, the availability of these drugs in the Syrian market during that period was the controlling factor, particularly considering the Syrian sanctions.

The exclusion criteria included couples with azoospermia and severe male factor, high BMI (> 30), previous poor responders, endometriosis, and women with a history of ovarian hyperstimulation syndrome.

Results: Results showed that the differences between the two groups favored group 1 in terms of the number of fertilized oocytes, the number of embryos, and the quality of the embryos, i.e. Top quality embryos (TQE).

Conclusion: Regardless of cost-effectiveness, we demonstrated that rhCG at a dose of 500 mcg is more effective than a combination of uhCG at 5000 IU with rhCG at 250 mcg when used for final oocyte maturation in ICSI cycles. The number of top-quality embryos was higher in Group 1, which used only rhCG at a dose of 500 mcg.

 Keywords: Ovulation Triggering; Recombinant hCG; Urinary hCG; Embryo Quality; Grading

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