ASSISTED REPRODUCTION TECHNOLOGIES
Human chorionic gonadotropin serum levels following ovulation
triggering and IVF cycle outcome
Received: 22 December 2017 /Accepted: 14 March 2018 /Published online: 23 March 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results.
Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with
Methods A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and
June 2016, was performed. hCG serum levels were obtained 10–12 h following ovulation triggering with 250 mcg r-hCG.
Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A
multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after
controlling for confounders.
Results Overall, 326 cycles were included. Median serum hCG level was 91.35 IU/L. hCG levels were lower as age and BMI
were higher (p =0.004,p < 0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p =0.14),
live birth rate (p = 0.09), fertilization rate (p = 0.45), or metaphase II oocyte rate (p = 0.68). On multivariate regression analysis,
hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98–1.005), after controlling for patient’s age and BMI.
Conclusions hCG levels on the day after ovulation triggering with 250 mcg r-hCG are inversely correlated with patient age and
BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after
ovulation induction seems futile and cannot be recommended.
Keywords Human chorionic gonadotropin
For more than five decades, human chorionic gonadotropin
(hCG) has been widely used for triggering the final stage of
follicular maturation in IVF and in ovulation induction treat-
ment cycles . Due to its high degree of homology with
luteinizing hormone (LH), hCG efficiently mimics the
mid-cycle LH surge, inducing ovulation, resumption of mei-
osis in the oocyte, and formation of the corpus luteum.
Furthermore, hCG plays a critical role in the complex process
of implantation, contributing to the receptivity of the
endometrium . It has been therefore postulated that serum
levels of hCG following ovulation triggering may be correlat-
ed with reproductive outcome [3–6].
The clinical significance of serum hCG levels after ovula-
tion triggering has been studied previously in a very limited
manner, and conflicting results have been obtained. Studies
have been conducted in two time points: either on the morning
after hCG administration (12–14 h after triggering), or on the
time of oocyte retrieval (after 34–36 h). Adding further to the
confusion, both the subcutaneous (SC) and intramuscular
(IM) routes, as well as recombinant and urinary preparations
in different doses, have been used. While Zhou et al. have
found that higher levels of hCG 12 h after IM urinary hCG
(u-hCG) administration were associated with a higher clinical
pregnancy rate, Shapiro et al.  failed to find such a correla-
tion. In addition, Matorras et al. studiedhCGlevels36h
after SC recombinant hCG (r-hCG) triggering and also found
that they were not associated with treatment outcome.
* Yossi Mizrachi
IVF Unit, Department of Obstetrics and Gynecology, The Edith
Wolfson Medical Center, 62 Halochamim St, POB 58100,
Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Journal of Assisted Reproduction and Genetics (2018) 35:891–897