Can in vitro fertilization cycles be salvaged by repeat administration of intramuscular human chorionic gonadotropin the day after failed injection?

This study investigated the incidence of failed hCG administration as evidenced by negative serum β-hCG after initial trigger injection, and the ability to salvage such cycles through repeat administration of hCG before retrieval.


David E Reichman, M.D., Eleni Greenwood, M.S., Laura Meyer, M.D., Isaac Kligman, M.D., Zev Rosenwaks, M.D.

Vol 98, Issue 3, Pages 671-674



To investigate the incidence of negative serum hCG after initial IM trigger injection and whether such cycles can be salvaged through repeat administration of IM hCG.


Retrospective cohort study


Academic medical center


All patients undergoing IVF at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College from January 1, 2005, to November 1, 2011.


Repeat hCG administration in cases of failed initial trigger

Main outcome measures:

Fertilization, implantation, clinical pregnancy, and live-birth rates were analyzed in the index population as compared to a control population matched for age, year of cycle start, diagnosis, stimulation protocol, number of prior IVF attempts, oocyte yield, and number of embryos transferred.


The incidence of failed initial IM hCG injection was low, occurring in only 0.25% of the 17,298 fresh IVF cycles occurring at our center over the study period. Of the 41 patients undergoing retrieval who received a second IM injection of hCG approximately 24 hours after the first, the live-birth rate was 39.02%. Compared to matched controls, there were no statistical differences in oocyte maturity, fertilization, implantation, clinical pregnancy, or live-birth rates.


While the incidence of failed hCG injection is rare, this study reveals that cycles characterized by incorrect initial administration or failed absorption of hCG can be salvaged by early detection and repeat injection. IVF-ART programs may benefit their patients through the assessment of either urine pregnancy tests or measurement of quantitative serum β-hCG prior to retrieval, thereby preventing empty follicle syndrome.

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