Conception rate with or without hCG trigger in clomiphene induced cycles

Aruna Verma, Abhilasha Gupta, Monika Kashyap, Juveriya Meraj


Background: Clomiphene citrate (CC) is still the most common drug for ovulation induction. Most physicians use hCG trigger routinely for follicle rupture. Ideally hCG is recommended only where there is no spontaneous LH surge. Hence this study was conducted to see the role of hCG for follicle rupture in CC induced cycle. Aims and objectives of the study were to compare the ovulation rate in CC induced cycle with or without hCG trigger and finally the conception rate.

Methods: Study was conducted in the department of OBG, LLRM medical college Meerut on women with anovulatory infertility. All women were given 50-100 mg CC. Follicular study from D-9 was done till follicle rupture. Women in group A were observed without any trigger and women in group B were given inj. hCG trigger 10,000 IU when follicle size reached 20-22 mm.

Results: Conception rates were 25% Vs 31% in group A and group B. Follicle rupture was seen in 84% cases in group A and 71% in group B. Results were comparable in both the groups.

Conclusions: By adding inj. hCG for ovulation trigger does not increase the conception rate. LH surge is already there in CC induced cycles. It is having role only in cases where no LH surge is there.



HCG trigger, Clomiphene citrate, Anovulatory infertility

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World Health Organization. Recent advances in medically assisted conception. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1992;820:1-111.

Teide H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8(1):41.

Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: The Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781-5.

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7.

Kistner RW, Smith OW. Observations on use of nonsteroidal estrogen antagonist: MER 25. II. Effects in endometrial hyperplasia and Stein-Leventhal syndrome. Fertile sterile. 1991;12;121.

Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Treatment of the Infertile Couple. In: Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG, eds. Williams Gynecology. 1st ed. New York, New York: McGraw-Hill Professional. 2008:450-51.

Management of infertility caused by ovulatory dysfunction. ACOG practice bulletin. Int J Gynecol Obstet. 2002;77:177-88.

Homburg R, Insler V. Ovulation induction in perspective. Hum Reprod Update. 2002;8:449-62.

Arici A, Byrd W, Bradshaw K, Kutteh WH, Marsh burn P, Carr BR. Evaluation of clomiphene citrate and human chorionic gonadotropin treatment: a prospective, randomized, crossover study during intrauterine insemination cycles. Fertil Steril. 1994;61:314-8.

Deaton JL, Clark R, Pittaway DE, Herbst P, Bauguess P. Clomiphene citrate ovulation induction in combination with a timed intrauterine insemination: the value of urinary luteinizing hormone versus human chorionic gonadotropin timing. Fertil Steril. 1997;68:43-7.

Zreik TG, Garcia-Velasco JA, Habboosh MS, Olive DL, Arici A. Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin-timed versus urinary luteinizing hormone-timed intrauterine inseminations in clomiphene citrate stimulated treatment cycles. Fertil Steril. 1999;71:1070-4.

Kistner RW, Smith OW. Observations on use of nonsteroidal estrogen antagonist: MER 25. II. Effects in endometrial hyperplasia and Stein-Leventhal syndrome. Fertil Steril. 1961;12:121.

Greenblatt RB. Chemical induction of ovulation. Fertil Steril. 1961;12:402.

Robb P, Robins JC, Thomas MA. Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate. JNMA. 2004;96(11):1431-3.

Yilmaz B. Addition of human Chorionic Gonadotrophin to clomiphene citrate ovulation induction therapy does not improve pregnancy outcomes and luteal function. Fertil Steril. 2006;85(3):783-6.

Kyrou D, Fatemi HM. Transfer of cryopreserved-thawed embryos in hCG induced natural or clomiphene citrate cycles yields similar live birth rates in normo-ovulatory women. J Assist Reprod Genet. 2010;27:683-9.

Melli MS, Tagavi S. Comparision the effect of Oxytocin and Human Chorionic Gonadotrophin on ovulation. J Med Sci. 2007;7:1126-34.

Fukuda J. Administering human chorionic gonadotrophin injections for triggering follicle maturation could impact fertility during the subsequent menstrual cycle. Int J Gynecol Obstet. 2016;132(3):309-13.