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.

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.

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.