Intrauterine injection of HCG before embryo transfer: a parallel, double-blind randomized trial

Karim S. Abdallah*, Ahmad Makhlouf, Esraa Badran, Ihab M. El-Nashar, Tarek K. Al-Hussaini, Tarek Farghaly, Hazem S. Mohamed, Ben W. Mol, Ahmed M. Abdelmagied

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Research question: Does intrauterine administration of HCG before embryo transfer improve live birth rate during IVF cycles? Design: A parallel, randomized controlled trial conducted between July 2018 and February 2020. Infertile women (n = 181) scheduled for fresh or vitrified–warmed embryo transfer after IVF carried out for any indication were randomized in a 1:1 ratio to receive either HCG (500 IU in 0.1 ml of tissue culture media) or culture media (0.1 ml of tissue culture media) via intrauterine injection 4 min before embryo transfer. In both groups, an intrauterine insemination catheter was used for administering the medication. Primary outcome was live birth, with ongoing pregnancy and clinical pregnancy as secondary outcomes. Analysis was based on intention-to-treat principle. Results: Baseline and cycle characteristics were comparable between the two groups. In the control group, one woman with a confirmed clinical pregnancy was lost to follow-up. Live birth rates were 24% (22/90) in the HCG group versus 19% (17/90) in the control group (RR 1.29, 95% CI 0.74 to 2.27). Clinical pregnancy and ongoing pregnancy rates were 34% versus 26% (RR 1.31, 95% CI 0.84 to 2.04) and 24% versus 19% (RR 1.29, 95% CI 0.74 to 2.27) in the HCG and the control groups, respectively. Conclusion: Intrauterine injection of HCG before embryo transfer did not improve live birth rates in women undergoing IVF. As the study was designed to detect a 20% difference between groups, a smaller, clinically important difference could not be ruled out. Treatment outcomes were lower than expected in the control group.

Original languageEnglish
Pages (from-to)663-669
Number of pages7
JournalReproductive Biomedicine Online
Issue number4
Early online date19 Jun 2021
Publication statusPublished - 31 Oct 2021

Bibliographical note

Funding Information:
We would like to thank Dr Rui Wang from Monash University for his valuable suggestions during the preparation of the manuscript. Assiut University Grants Office financed this study to supply the drug (HCG) and the IUI catheters.

This study was funded by Assiut University Grants Office. BWM is supported by a NHMRC Investigator grant (GNT1176437). BWM reports consultancy for Guerbet and ObsEva. BMW has received research funding from Guerbet, Ferring and Merck.; KSA reports research scholarship funding at Monash University by the Missions Department of the Egyptian Ministry of Higher Education. The preliminary result of this work was presented at the ASRM 2020 Virtual Scientific Congress and was published online in the Fertility and Sterility Abstract Supplement in October 2020.


  • Embryo transfer
  • Human chorionic gonadotropin
  • In vitro fertilization
  • Intrauterine injection
  • Live birth


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