Effect of Intrauterine Injection of Human Chorionic Gonadotropin at the Day of Ovum Pick-Up on Patients Undergoing ICSI for Recurrent Implantation Failure

Abstract

Summary I mplantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood (Cakmak and Taylor, 2010). Several approaches have been implemented to increase endometrial thickness, and presumably prepare it for the “window of implantation”. The cross-talk between the endometrium and the developing embryo is mediated by many substances, including cytokines (IL1, IL6 and its product LIF), integrins, adhesion molecules, metallo proteins, growth factors, prostaglandins and hormones such as hCG, all of which support the process of apposition, adhesion and invasion, (Achache and Revel, 2006). Major advances have occurred in clinical and laboratory IVF techniques in recent years; however, the pregnancy rates remain around 30% per cycle (de Mouzon et al., 2002). In order to improve pregnancy outcomes in women with RIF, various investigations and treatment adjuncts have been studied(Margalioth et al., 2006). The current study aimed to investigate the value of intrauterine injection of hCG at day of ovum pick-up in an attempt to improve implantation and pregnancy rates on patients with recurrent implantation failure. A total 100 patients were included in the study, randomized and divided into two groups: - Group (1): The study group;included 50 patients who were injected by 500 IU of hCG intrauterine at the day of ovum pick-up. - Group (2): The control group; included 50 patients, age matched, who underwent the study without intrauterine injection. Participants who were included in this study were 20 to 35 years old and had this ICSI traial after one or more previous failure. Patients who were excluded from the study were any female with any local cause, uterine pathology, e.g: uterine myoma or previous myomectomy, endometriosis or the presence of hydrosalpinges, patients undergoing ICSI trial for the first time, or patients with previous Asherman Syndrome.