Induction of ovulation with subcutaneous pulsatile gonadotropin-releasing hormone: correlation with body weight and other parameters

Serum human chorionic gonadotropin levels are correlated with body mass index rather than route of administration in women undergoing in vitro fertilization--embryo transfer using human menopausal gonadotropin and intracytoplasmic sperm injection

OBJECTIVE

To compare subcutaneous (SC) and intramuscular (IM) hCG administration and their association with body mass index (BMI) in women undergoing IVF-ET using hMG and ICSI.

DESIGN

Prospective, randomized controlled trial.

SETTING

Private infertility clinic.

PATIENT(S)

Twenty-one ovulatory women, 29-39 years, were enrolled. Treatment of one patient who failed to respond to hMG was canceled.

INTERVENTION(S)

A standard IVF-ET treatment plan using an initial dose of 300 U of hMG was followed. Patients were randomly assigned to receive 10,000 IU hCG, either IM in the gluteal region or SC in the lower abdomen. Exactly 12 hours later, serum for hCG determination was obtained. All oocytes were fertilized using ICSI technology.

MAIN OUTCOME MEASURE(S)

Human chorionic gonadotropin levels 12 hours after injection, BMI, and oocyte maturity.

RESULT(S)

No significant differences in hCG levels were found, with mean levels of 225 +/- 24 mIU/mL for SC injection versus 213 +/- 26 mIU/mL for IM injection. No differences were observed in the percentage of mature oocytes. A significant negative correlation was found between BMI and hCG levels in all patients, regardless of route of administration.

CONCLUSION(S)

The highest levels of hCG were measured in women with the lowest BMI. Patients' body size, rather than route of hCG delivery, appears to determine circulating levels of hCG.

Maternal nutrition and obstetric outcome

In general, maternal nutritional status in civilized countries is not at risk. However, even a marginal malnutritional state for some (micro)nutrients for the pregnant women can adversely affect obstetrical outcome. From the data available so far, only folic acid supplementation is advised. However, the importance of an adequate iron and zinc status has to be stressed. In addition, women should be warned preconceptionally about excessive intake of vitamins, especially of those products containing large amounts of vitamin A.

Induction of ovulation with human pituitary gonadotrophin. Twelve years' experience

Twelve years' experience in the therapeutic use of human pituitary gonadotrophins in 74 patients with anovulation is reviewed. Of these 74 patients, 54 conceived on at least one occasion. A new development, the use of radioimmunoassays for oestrone-3-glucuronide and pregnanediol-3-glucuronide to monitor responses, has been shown to be as effective as the more laborious chemical methods which were previously used. The adoption of radioimmunoassay monitoring allows the simultaneous treatment of up to five patients, and will markedly reduce existing waiting lists for this treatment.