Efficacy and safety of human chorionic gonadotropin for follicular phase stimulation in assisted reproduction: a systematic review and meta-analysis.

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of hCG to induce follicular stimulation. DESIGN: Systematic literature searches of PubMed, EMBASE, CENTRAL, and SciSearch databases. Randomized controlled trials (RCTs) using hCG in early or late follicular phases were included. SETTING: Three reproductive medicine services of gynecology in Spain and two universities. PATIENT(S) A total of 1,068 women treated in 11 RCTs were included. INTERVENTION(S) Use of hCG versus other hormone treatments, no administration, or placebo during the period of follicular stimulation. MAIN OUTCOME MEASURE(S) Live birth, clinical pregnancy, mature oocytes, miscarriage, ovarian hyperstimulation syndrome (OHSS), and FSH doses. RESULT(S) No differences in live birth, miscarriage, and OHSS rates between hCG (given at either the early or late follicular phases) and different control regimens were found. Pooled analysis for clinical pregnancy showed significant differences in favor of hCG at the late follicular phase. The doses of FSH were lower in women treated with hCG at either the early or late follicular phase than in those treated with FSH alone. CONCLUSION(S) The use of hCG in the early and late follicular phase in controlled ovarian stimulation has the advantage of decreasing the doses of FSH.