Does triggering ovulation by 5000 IU of uhCG affect ICSI outcome?*

Objective: To evaluate the effect of 5000 IU as compared to 10000 IU of uh CG on the outcome of ICSI cycles.Study Design: A prospective randomized double blind clinical trial.Setting: Dr. Samir Abbas Medical Center, Jeddah, KSA.Material and methods: One hundred patients scheduled for ICSI were recruited for the study. Inclusion criteria included: age 35 years, BMI 30 kg/m2 and basal FSH 10 IU/l. Patients were excluded from the study if they had:PCOS, history of OHSS, or history of previous cancellation due to poor response. Long down-regulation using GnRHa, was confirmed by serum LH levels 2 IU/l and serum E2 50 pg/ml after which stimulation with hMGwas started and continued until one follicle was .18 mm and at least 2 other follicles . 16mm with serum E2 level ≤ 50 pg/ml per follicle. Two patients were with drawn from the study before randomization ,1 had OHSS while the other had poor response. A total of 98 patients were then randomly divided into 2 groups: group I (n=50)received 5000 IU and group II (n=48) received 10000 IU uhCG via intramuscular route.Main Outcome Measures : total number of oocytes retrieved, oocyte recovery rate, number of mature oocytes,fertilization and pregnancy rates , serum progesterone (P) on day 6-7 post hCG and incidence of OHSS.Results: There was no difference (mean ± SD) between patients in group I and II regarding age (27.6±4.1 versus27.2±3.9),BMI (25.8±2.3 versus 25.6 ±2.2 kg/m2) and basal FSH (6.3±1.7 versus 6±1.8 IU/l) respectively. Therewas no significant difference between both groups regarding oocyte recovery rate (87% versus 90%) ,total numberof oocytes retrieved (7±3.5 versus 7.4 }3), number of mature oocytes (5.6 ±3 versus 5.9 }2.6) fertilization rate (71%versus 76%) and pregnancy rate ( 33.3% versus 35.4%), respectively. Serum P on day of oocyte retrieval was(18.5 }11.3 versus 19.8 }11.5) while on day 6-7 post hCG it was (182.8 ±versus 177±108.9), with no significant difference between both groups. The incidence of OHSS was higher in group II : 4 patients (8.33%) as compared toonly 1 patient (2%) in group I ;all were mild cases. However, this difference was not statistically significant.Conclusion: Single dose of 5000 IU uhCG used for triggering ovulation is as effective as 10000 IU on the outcome of ICSI cycles with the added advantage of reduced incidence of OHSS.