الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
IVF is not an effective treatment as it is hoped to be, considering that it is an expensive procedure that result in success for less than half those receiving it. Therefore, the search for the best method to improve the success rates of IVF remains an important research question. Hence, several interventions have been proposed to be added to IVF cycles to improve their success rates; one of which is the intrauterine administration of hCG before embryo transfer. Objectives: We designed a study aiming to investigate the effectiveness and safety of injecting 500 IU of hCG inside the uterine cavity before embryo transfer in women undergoing IVF with live birth as the primary outcome. 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. Recommendations for clinical practiceSeveral IVF add-ons were proposed to improve the outcomes without robust establishment of their beneficial or adverse effects, exposing the IVF women to the risk of malpractice and unnecessary financial burden especially in low resource settings, one of which is the intrauterine injection of hCG (Lensen et al., 2019). This double-blind randomized trial did not show a significant increase in live birth rate associated with the injection of 500 IU inside the uterine cavity before embryo transfer during IVF. Therefore, we do not recommend its implementation in the routine clinical practice at this stage. As the study was designed to detect a 20% difference between groups, a smaller, clinically important difference could not be ruled out. Recommendations for researchLarger RCTs are needed to exclude clinically important smaller effect of the intervention than could have been missed in this study. Additionally, a systematic review with individual participant data meta-analysis of all conducted RCTs should be done to detect any possible subgroup with specific characteristics that might benefit from this intervention.