Final maturation of follicles has, in connection with ovarian stimulation and infertility treatment, traditionally been achieved by the administration of a human chorionic gonadotropin (hCG) bolus trigger of 5,000 to 10,000 IU. This trigger serves two purposes: induce oocyte maturation; and serve as luteal phase support owing to its long half-life. It now appears that the hCG bolus trigger is unable to support both these two purposes optimally. In particular, after an hCG trigger, the early luteal phase is hormonally abnormal and different from conditions observed in the natural menstrual cycle: the timing of the initiation of hCG and progesterone rise is much faster after an hCG trigger than in a natural menstrual cycle; the maximal concentrations of hCG and progesterone considerably exceed those naturally observed; and the timing of the peak progesterone concentration after an hCG trigger is advanced several days compared with the natural cycle. Furthermore, the hCG trigger without any follicle-stimulating hormone activity may induce oocyte maturation less efficiently than the combined luteinizing hormone and follicle-stimulating hormone surge normally seen. Collectively, the endometrium is likely to be advanced after an hCG trigger, and the implantation potential is probably not optimal. The precise effect on pregnancy rates after the different progressions of hCG and progesterone concentrations during the early luteal phase has not yet been determined, but more individualized methods using more physiological approaches are likely to improve reproductive outcomes.

中文翻译：

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使用人绒毛膜促性腺激素非生理触发卵母细胞成熟的缺点

与卵巢刺激和不孕症治疗相关的卵泡最终成熟传统上是通过施用 5,000 至 10,000 IU 的人绒毛膜促性腺激素 (hCG) 推注触发器来实现的。这个触发器有两个目的：诱导卵母细胞成熟；由于其半衰期长，可作为黄体期支持。现在看来 hCG 推注触发器无法最佳地支持这两个目的。特别是，在 hCG 触发后，早期黄体期激素异常，与自然月经周期中观察到的情况不同：hCG 触发后开始 hCG 和孕激素升高的时间比自然月经周期快得多；hCG 和黄体酮的最大浓度大大超过了自然观察到的浓度；与自然周期相比，hCG 触发后黄体酮浓度峰值的时间提前了几天。此外，没有任何促卵泡激素活性的 hCG 触发器可能比通常看到的黄体生成素和促卵泡激素激增的组合更有效地诱导卵母细胞成熟。总的来说，子宫内膜在 hCG 触发后可能会提前，并且植入潜力可能不是最佳的。在黄体早期，hCG 和孕酮浓度的不同进展对妊娠率的确切影响尚未确定，但使用更多生理方法的更个性化的方法可能会改善生殖结果。