HCG timing

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  • HCG timing Prof Aboubakr Elnashar Benha university Hospital, EgyptAboubakr Elnashar
  • Ovulation trigger The end point of any ovulation induction protocol is to indentify the best time for triggering ovulation. Most crucial step Critical timing for HCG administation depends on the criteria for follicular maturity 1. Follicular diameter 2. Serum E2 3. Endometrial thickness Always time HCG with follicle size Gnt follicles mature at 15-18 mm CC follicles mature at 18-20 mm (Sperof,f 2005) Aboubakr Elnashar
  • HCG ovulation triggers substitute for LH surge seen in spontaneous menstrual cycles Control the timing of ovulation Timing of SI. Timing of IUI Timing of OR HCG has a half-life of about 35 h: support the initial part of the luteal phase. Aboubakr Elnashar
  • HCG similar activity to LH and binds to its receptor. capable of inducing luteinization and ovulation. Ovulation: 38 to 40 h after HCG injection. 2 types: urinary and recombinant Urinary HCG dose: 5000-10,000 IU, IM. Recombinant HCG: Dose: 250 mcg, SC. similar pharmacokinetics as the u HCG: ovulation is expected following a similar time interval. Aboubakr Elnashar
  • Preparation Trade name Route U.pr Price Company Urinary HCG Pregnyl Profasi IM 95% Organon Serono H.P.HCG Choriomon SC, IM 25mIU/ml ovulation must be expected to occur on average as early as 24 h, after a positive urine test. If one adds a fertilizing life span for the ovulated ovum of only 12 h to be on the safe side, IUI 36 h after positive urine test is very satisfactory.Aboubakr Elnashar
  • Serum LH surge: 12 h Urine LH surge (serum LH peak): 24 h Follicular rupture lunch-time (11.0-15.00) is the best time to check for the LH surge using urine dipsticks and insemination at any time between 18 and 53 h after the onset of the surge will produce optimal results (Khattab et al, 2005). A spontaneous LH surge was noted in a variety of follicular sizes (14 to 35 mm) (Vlahos et al, 2005) Aboubakr Elnashar
  • 2. U/S and HCG triggering a. Follicles: The exogenous HCG mimics the endogenous LH surge & offers the advantages that the onset of LH surge is known precisely. HCG is given when the leading follicle is 17-20 mm. HCG should be withheld if > 3 follicles > 16 mm: (Macklon et al, 1999). >4 follicles 14 mm (Kamrava et al., 1982; Hugues et al., 2006). Aboubakr Elnashar
  • b. Endometrial thickness: