Fanchin, R., Peltier, E., Frydman, R., & de Ziegler, D. (2001). Human chorionic gonadotropin: does it affect human endometrial morphology in vivo? Seminars in Reproductive Medicine, 19(1), 31-35. https://doi.org/10.1055/s-2001-13908
Fanchin R, Peltier E, Frydman R, de Ziegler D. Human chorionic gonadotropin: does it affect human endometrial morphology in vivo? Semin Reprod Med. 2001;19(1):31-35. doi:10.1055/s-2001-13908
Fanchin, Renato, et al. "Human chorionic gonadotropin: does it affect human endometrial morphology in vivo?" Seminars in Reproductive Medicine, vol. 19, no. 1, 2001, pp. 31-35.
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Université de Versailles Saint-Quentin-en-Yvelines03mkjjy25
hCG injection appears to change uterine lining tissue in seven women
A review describes a seven-woman crossover study finding that an hCG injection changes uterine lining tissue. The women had inactive or absent ovaries. Biopsies from hCG cycles showed fewer cell divisions and higher histologic scores than biopsies from control cycles.
Key Findings
Seven volunteers aged 23 to 35 with inactive or absent ovaries received estradiol with an hCG injection in one cycle. Five of the seven also completed a control cycle without hCG.
Cell divisions (mitoses) per high-power field were lower with hCG: 1.3 ± 0.2 versus 2.8 ± 0.6 in glands and 1.9 ± 0.5 versus 3.0 ± 0.4 in stroma (P <.05).
In biopsies taken six days after hCG, glands were more coiled, and single-layer gland structure and stromal spiral arteries were more common, than in control cycles.
The authors' 0 to 10 scoring gave hCG cycles a median of 6 (range 5 to 10) and control cycles a median of 1 (range 1 to 4) (P <.04).
Earlier laboratory studies the authors cite found that gonadotropins, including hCG, led cultured endometrial stromal cells to acquire decidualized features, and hCG/LH receptors have been identified in nonpregnant human endometrium.
Interpretation
This review describes one prospective crossover study. The authors chose women with inactive or absent ovaries so the effect of hCG on the endometrium could be studied apart from ovarian hormones. The authors note that the practical effect on embryo implantation remains to be determined. The findings support further study of hCG's direct effect on the endometrium.
RRM Context
The authors note that natural LH surges fail to occur in ovarian stimulation for IVF. Stimulation relies on an injected hormone, hCG, to trigger ovulation. Restorative reproductive medicine starts from the body's own ovulation and works to restore it. IVF bypasses ovulation and proceeds without finding out why conception fails.
Our editorial summary of this paper, not the article's abstract.
Abstract
Human chorionic gonadotropin (hCG) is widely used as a surrogate to luteinizing hormone (LH) to trigger ovulation in controlled ovarian hyperstimulation (COH). Yet this molecule may exert direct effects on the endometrium. These effects, not mediated by ovarian hormones, are probably a consequence of stimulation of endometrial hCG/LH receptors. Because the half-life of hCG differs markedly from that of LH, possible pharmacological effects of hCG on the endometrium could alter endometrial receptivity in COH. Arguments supporting a clinical action of gonadotropins, and hCG in particular, on the endometrium abound. Notably, evidence has been reported of decidualization of stromal cells of the human endometrium in vitro as a result of exposure to gonadotropins, including hCG. The present article discusses, from a clinical standpoint, the main basis supporting the hypothesis that hCG administration as commonly used in infertility treatments may exert direct effects in vivo on endometrial histology and partake in endometrial transformations of the luteal phase. Preliminary results suggest that endometrial effects of hCG exist in vivo and should be taken into account when assessing the endometrial effects of hormones.
