Can in vitro fertilization cycles be salvaged by repeat administration of intramuscular human chorionic gonadotropin the day after failed injection?

OBJECTIVE

To investigate the incidence of negative serum hCG level after initial IM trigger injection and whether such cycles can be salvaged through repeat administration of IM hCG.

DESIGN

Retrospective cohort study.

SETTING

Academic medical center.

PATIENT(S): All patients undergoing IVF at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, from January 1, 2005 to November 1, 2011.

INTERVENTION(S): Repeat hCG administration in cases of failed initial trigger.

MAIN OUTCOME MEASURE(S): Fertilization, implantation, clinical pregnancy, and live birth rates were analyzed in the index population compared with a control population matched for age, year of cycle start, diagnosis, stimulation protocol, number of prior IVF attempts, oocyte yield, and number of embryos transferred.

RESULT(S): The incidence of failed initial IM hCG injection was low, occurring in only 0.25% of the 17,298 fresh IVF cycles at our center during the study period. Of the 41 patients undergoing retrieval who received a second IM injection of hCG approximately 24 hours after the first, the live birth rate was 39.02%. Compared with matched controls, there were no statistical differences in oocyte maturity, fertilization, implantation, clinical pregnancy, or live birth rates.

CONCLUSION(S): Although the incidence of failed hCG injection is rare, this study reveals that cycles characterized by incorrect initial administration or failed absorption of hCG can be salvaged by early detection and repeat injection. Assisted reproductive technology (ART) programs may benefit their patients through the assessment of either urine pregnancy tests or measurement of quantitative serum β-hCG levels before retrieval, thereby preventing empty follicle syndrome.