Study question

Does it matter whether deprivation of follicular stimulation hormone (FSH) over 24 hours? Does additional FSH administration on the day of hCG trigger improve cycle outcomes in COH IVF cycles?

Summary answer

FSH administration on the day of hCG trigger does not have beneficial effects on cycle outcomes, such as the number of oocyte, fertilization rate, embryo quality and pregnancy rate.

What is known already

Ovarian stimulation protocols are very diverse and there are some differences depending on clinicians. If women receive no FSH on the day of hCG trigger, the interval between last FSH administration and hCG trigger is more than 24 hours. On the contrary, the time gap is less than 24 hours with FSH administration on hCG day. Time gap might have adverse effect on cycle outcomes if it is increased.

Study design, size, duration

This retrospective study included 1289 women undergoing COH IVF cycles between January 2012 and December 2013.

Participants/materials, setting, methods

We retrospectively reviewed 1289 patients undergoing IVF using GnRH agonist and antagonist protocols. On the day of hCG trigger, 116 women received additional FSH (FSH Group) and 1172 women did not receive FSH (No FSH Group).

Main results and the role of chance

In each group, age (35.1±4.5 vs. 36.0±4.2), the number of oocytes (9.9±6.2 vs. 10.0±6.2), the number of transferred embryos (2.0 vs. 2.0) and fertilization rate (69.5% vs. 69.4%) did not show significant differences. There were no significant differences between two groups in the pregnancy rate [50.0%(58/116) vs. 49.5%(580/1172), P=0.332] and ongoing pregnancy rate [44.0%(51/116) vs. 45.4%(532/1172), P=0.262].

Limitations, reasons for caution

This is a retrospective study. The sample size of FSH Group is small in this study. Prospective randomized studies with larger sample size will be needed to confirm our conclusions.

Wider implications of the findings

Many clinicians usually do not give additional FSH on the day of hCG trigger. In this situation, some women do not receive FSH over 36 hours like coasting. It could have adverse effect on cycle outcomes. However, additional FSH administration on the day of hCG trigger does not have beneficial effects on cycle outcomes, such as the number of oocyte, fertilization rate, embryo quality and pregnancy rate. The time gap between last FSH administration and hCG trigger does not impact on cycle outcomes of COH IVF cycles.

Study funding/competing interest(s)
Funding by hospital/clinic(s)

Mamapapa&baby Obstetrics & Gynecology clinic