A major side-effect of controlled ovarian hyperstimulation (COH) in patients with polycystic ovary or polycystic ovarian syndrome (PCOS) is the risk of ovarian hyperstimulation syndrome (OHSS). In-vitro maturation (IVM) of immature oocytes represents a potential alternative for the fertility treatment of these patients. Recently, applications of FSH (hMG) or hCG priming have been used before immature oocyte retrieval to improve the success rate of IVM procedures.Although it is still controversial, hCG priming before oocyte retrieval seems beneficial in terms of easier oocyte retrieval, easier oocyte identification under stereomicroscope, maturation competence, and may increase the harvest of in vivo mature oocytes. Recently, new approaches attempted to improve the IVM program such as extending hCG stimulation or optimal hCG timing before immature oocyte retrieval. Therefore, as a first option, hCG-priming IVM treatment can be offered to women with PCO(S) instead of conventional IVF treatment with ovarian stimulation. In this session, I would like to introduce you to the recent progress of IVM cycles after hCG priming.

Introduction: Human chorionic gonadotropin for the final maturation of eggs in the In-vitro fertilization cycle was associated with the possibility of a negative effect on endometrial acceptance, fetal quality and ovarian hyper stimulation syndrome. Replacing it with a gonadotropin-releasing hormone agonist to trigger final ovulation is expected to reduce these effects. Therefore, this study was performed with aim to evaluate the outcome of triggering in in vitro fertilization with antagonist protocol by gonadotropin-releasing hormone agonist, human chorionic gonadotropin simultaneously with human gonadotropin-releasing hormone agonist and human chorionic gonadotropin. Methods: In this randomized clinical trial study conducted in 2015 and 2016, women were divided into three random groups after preparing the follicles for triggering and ovum retrieval. One group received 0. 2 mg of dipherline, the second group received 10, 000 units of human chorionic gonadotropin and the other group received 0. 2 mg of dipherline along with 1500 units of human chorionic gonadotropin. The number and quality of eggs and embryos were the outcomes of the study. Data were analyzed by SPSS software (version 17) and Leven tests and one-way analysis of variance. P < 0. 05 was considered statistically significant. Results: The number of retrieved oocytes in the group receiving gonadotropin-releasing agonist was significantly higher than the other groups (p = 0. 001). More embryos were produced in the gonadotropin-releasing hormone agonist group compared to the other two groups (p = 0. 009). However, the number of high quality embryos produced in the groups was similar. Conclusion: The onset of final oocyte maturation with gonadotropin-releasing hormone agonist significantly increases the number of retrieved oocytes and obtained embryos. However, dual stimulation using low-dose human chorionic gonadotropin (IU1500) and gonadotropin-releasing hormone agonist did not alter quality of embryo compared to the standard dose of human chorionic gonadotropin (IU10000).

Introduction: The purpose of this study was to evaluate the relationship between the beta-hCG cervicovaginal secretion and preterm delivery.Material & Methods: In this study a cross-sectional analysis was used and cervicovaginal secretion specimens were obtained from women in their 24th- 36thweeks (each 6 days) of pregnancy who visited the emergency clinic with preterm labor symptoms. Exclusion factors include: ruptured preterm (PROM), poly hydroamnios, multiple gestation, abruptio placental, placenta previa, cervical cerglege, amniocentesis, bleeding, coitus during the past 24 hours, smoking, systemic diseases, gestational hypertension or pre eclampsia, history of ovarian cyst, chorioamnionitis, use of corticosteroid before sampling, fetal abnormalities, intra uterine growth restriction, use of lubricant or vaginal cream during past 24 hours and dilatation more than 3 cm. Samples were frozen at -200 centigrade and transferred to laboratory immediately and examined with Radio immunoassay method in 72 hours. Then, the patients were explored for the occurrence of preterm or term delivery. Results: The results showed that mean of Beta hCG level in cervicovaginal secretion was higher in group 1 (preterm labor and delivery) than group 2 (preterm labor and term delivery) and group 3 (control). The mean± standard error for human chorionic gonadotropin level in 24th- 26th weeks in groups 1, 2, 3 were (33.5 ±10.16), (7.12±6.46) and (0), in 27th - 29th weeks in groups 1,2,3 was (30.28±8.23) (23±13.44) and (7.80±4.74), 30th - 32nd weeks in group 1, 2, 3 was (30.20±2.23), (18.85±5.65) and (16.25±8.57), 33th - 35th weeks in group 1, 2, 3 was (36.90±5.98), (22.32±6.35) and (10.70±4.67), 36th weeks in group 1,2,3 was (38.76±10.99), (20.05±19.73) and (8.42±5.89), respectively. According to the results obtained in weeks gestation, the range of values for human chorionic gonadotropin in three pregnant. groups was extensive and Beta hCG Level mean became more extensive in 24th -26th weeks. ROC curve showed that Beta hCG cervicovaginal level, equal to or more than 22.5milli unit per milliliter, is associated with preterm delivery (97% sensitivity, 76% specifity, 81% positive predictive value, 96% negative predictive value). However the cut off for groups 2 and 3 was 18 mlu/ml (100% sensitivity, 93% specifity, 94% positive and 100% negative predictive value, respectively). However, the cut off for the second and third groups was 18 mlu/ml (48% sensitivity, 93% sepcifity, 87% positive and 62% negative, respectively). Conclusion: Measuring the b-hCGlevel in cervicovaginalsecretionsof the patientscan predictpreterm delivery.

hCG is a generic name for 5 biologically active molecules that share a common a and b subunit amino acid sequence. These 5 molecules have key biological function in human pregnancy and human cancer. This review examines these molecule in detail. These 5 molecules, hCG, sulfated hCG, hyper glycosylated hCG, hCG free s and hyper glycosylated free s are produced by placental syncytiotrophoblast cells and pituitary gonadotrope cells (group 1), and by placental cytotrophoblast cells and human malignancies (group 2). Group 1 molecules are both hormones that act on the hCG/LH receptor. These molecules are central to human menstrual cycle and human pregnancy. Group 2 molecules are autocrines that act by antagonizing a TGFs receptor. These molecules are critical to all advanced malignancies.The hCG groups are molecules critical to both the molecules of pregnancy or human life, and to the advancement of cancer, or human death.

The aim of this study was to investigate the effect of replacing equine chorionic gonadotropin (eCG) with human chorionic gonadotropin (hCG) and also improving the efficiency of hCG using a slow-release compound (alhydrogel) on the reproductive performance of Afshari ewes after laparoscopic artificial insemination. For this purpose, 48 Afshari ewes (2.5-4 years old with the mean weight of 68±2.5kg and an body condition score of 3.04±0.3 were treated with intravaginal controlled internal drug release (CIDR) for 14 days. The ewes were then divided into 4 groups: the first group: injection of eCG (400IU), 48 hours before CIDR removal (eCGS), the second group: injection of eCG (400IU) combined with alhydrogel, 48 hours before CIDR removal (eCGSR), the third group: injection of hCG (400IU), 48 hours before CIDR removal (hCGS) and the fourth group: injection of hCG (400IU) combined with alhydrogel, 48 hours before CIDR removal (hCGSR). The results showed that there was no significant difference between eCGSR and eCGS treatments in Measured parameters (P>0.05). The lowest pregnancy rate (25%) and fecundity (33%) were recorded in related to the hCGS treatment. However, in the hCGSR treatment, these parameters were increased to the values recorded in eCGSR and eCGS treatments. The results of this study showed that hCG in the presence of slow release compound can be a suitable substitute for eCG in the estrus synchronization protocol based on progesterone and eCG.

Background: Gonadotropin-releasing hormone agonists (GnRH-a) was increasingly used for triggering oocyte maturationfor the prevention of ovarian hyperstimulation syndrome. Studies suggest that GnRH-a might be used as a better trigger agent since it causes both Luteinizing hormone and follicle stimulating hormone release from a physiologic natural cycle. Objective: The aim of this study was to evaluate the effect of dual-triggering in assisted reproductive technology outcomes. Materials and Methods: 192 normal responder women aged ≤ 42 years and 18< Body Mass Index <30 kg/m2 enrolled in this single-blind randomized controlled trial. All participants received antagonist protocol. For final triggering, women randomly were divided into two groups. Group, I was triggered by 6500 IU human chorionic gonadotropin (hCG) alone, and group II by 6500 IU hCG plus 0. 2 mg of triptorelin. The implantation, chemical, clinical and ongoing pregnancy, and abortion rates were measured. Results: The mean of retrieved oocytes and obtained embryos were statistically higher in the dual-trigger group (group I), but the implantation and pregnancy rates were similar in two groups. Conclusion: The results of our study did not confirm the favorable effect of dual-triggered oocyte maturation with a GnRH-a and a standard dosage of hCG as an effective strategy to optimize pregnancy outcome for normal responders in GnRH-antagonist cycles. We think that this new concept requires more studies before becoming a universal controlled ovarian hyperstimulation protocol in in vitro fertilization practice.

Introduction: This prospective study evaluated the efficacy of a small bolus of hCG administered on the day of ovulation induction with a GnRH agonist versus standard dose hCG on reproductive outcomes.Materials and Methods: One hundred forty infertile patients after a GnRH antagonist protocol. Ovulation induction was performed with either 10, 000 IU hCG (n=70) or 0.2 mg GnRHa (triptirelin) supplemented with 2, 500 IU hCG (n=70) on the day of ovulation induction. Reproductive outcomes in two groups were compared.Results: Significant difference was seen regarding positive hCG (51.4% and 31.4%) between the GnRHa and 10, 000 IU hCG groups, but there were no significant differences in clinical pregnancy (40% and 25.7%) and ongoing pregnancy (34.3% and 21.4%) between two groups.Conclusion: A small bolus of hCG in the GnRHa group secured the luteal phase, resulting in a comparable reproductive outcomes in the two groups.