Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 47 Issue 1 (2020). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.
Purpose: To demonstrate that the injection of human chorionic gonadotropin (hCG) intramuscularly for purpose of timing of an intrauterine insemination (IUI) can cause an oocyte to fail to rupture from the follicle. Materials and Methods: A 33-year-old woman sought help for infertility that seemed related to a male factor problem. The office performed IUI’s morning and evenings on weekdays but only in the morning on weekends. The timing of IUI was generally 40 to 48 hours after the initiation of the luteinizing hormone (LH) surge. When a follicle reached a minimum E2 of 200 pg/mL and an ultrasound with at least one follicle of an average of 20 mm, an injection of hCG 10,000 units I.M. was given in the evening on a Thursday or Friday, for an IUI on Saturday or Sunday. Weekday IUI’s were based on endogenous LH surge. Ultrasounds were performed on the day of IUI and the next day, if no oocyte was released. Release was considered to have occurred if shrinkage of the follicle by >5 mm took place without the serum P exceeded 2 ng/dL. Results: In six natural cycles where IUI was performed Monday-Friday, the peak sera E2 levels reached 368, 334, 337, 465, 365, and 355 pg/mL. Oocyte release was confirmed in all six cycles. There were two cycles where hCG was given for weekend IUI’s. In neither cycle was oocyte release demonstrated. Leuprolide acetate also failed to cause oocyte release. Discussion: Though hCG injection and GnRH agonists can correct the luteinized unruptured follicle (LUF) syndrome, in some instances, hCG and GnRH agonists can actually cause LUF syndrome.