Intra-uterine hCG at Embryo Transfer: “Jump-Starting” the Implantation Process


Dr Robert Greene - CNY Fertility CenterDuring the IVF process, the emphasis has traditionally been on creating the best possible embryos for transfer. Although this embryo based approach has lead to a steady improvement in pregnancy rates for IVF patients; success rates have reached a plateau during the last decade. It seems appropriate therefore that we now step back and devote similar efforts to bolster implantation by improving the receptivity of a woman’s uterus. Such was the recommendation of a 2006 review article [r1] that suggested in its title that the “…endometrium is a fertility determining factor.” Yet only recently have practical ideas verified how we can optimize the chance for a healthy embryo to implant and grow.
Although most clinics monitor the ultrasound appearance of the endometrium (the lining of a woman’s uterus) this does not always reflect the hormonal, immunologic and nutritional environment where the embryo is expected to implant and grow. In 1998 a study [r2] demonstrated that a small amount of the hormone called “human chorionic gonadotropin (hCG) can be placed into the uterus and trigger a cascade of events that improve implantation. In fact, we now understand that process of “implantation” involves the embryo being “engulfed” as the tissue grows up and around the embryo. hCG promotes that process to take place. This same critical hormone promotes beneficial changes in the uterine muscle and the immune cells in the uterus necessary to enhance pregnancy.
A recent study [r3] measured the effect of putting a small drop containing 500 IU of hCG in the uterus immediately before an embryo transfer. They demonstrated about a 30% improvement in implantation and on-going pregnancy in women that received this treatment. They also tested smaller doses and found no improvement—further supporting that a crucial level of hCG is necessary to induce this measured benefit. As a result of this information, we are encouraging the use of 500 IU of Intra-uterine hCG as part of our embryo transfer routine.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at
Call our toll-free number at 800.539.9870 or request a consult here.

17 replies
  1. Denise
    Denise says:

    This is really interesting! I researched the trails and other articles online as well. We are now considering using intrauterine HCG at our next FET!

    • Lisa Stack
      Lisa Stack says:

      Hi Minerva,
      We will order a patient one HCG to be used with their FET. If not covered by your insurance, we can utilize a specialty mail order pharmacy. The cost is approximately $100 and we have it shipped directly to our office for you. This cost is not included in the FET price.
      If you have any additional questions, please feel free to contact our office!

  2. Penny
    Penny says:

    Have any studies been done that show if results are similar for older women? Also, has anyone looked at checking blood level HCG just prior to implantation to see if any correlations can be made?

    • Lisa Stack
      Lisa Stack says:

      Hi Penny,
      According to Dr. Greene, there have not been any studies showing similar results in older women, or preimplantation hcg levels. Please feel free to contact our office with any further questions.

    • Lisa Stack
      Lisa Stack says:

      Hi Penny,
      We would like to also add that although there have been no formal studies on the matter, that does not mean that there would be no benefit. Please let us know if there is anything else that we can do for you!

  3. michelle
    michelle says:

    Is the hcg a common practice now or do we need to ask for it? I am a new patient with you and am in my testing month.

    • Lisa Stack
      Lisa Stack says:

      Hi Michelle,
      We are offering this across the board for all clients. However, please feel free to always let us know if you have any questions or would like to confirm that we are using hcg with your transfer.
      Best of luck, and thanks for asking!

  4. Emily
    Emily says:

    Interesting article, thanks for posting. Would this prove to be beneficial with implantation in cases of insemination, as well?

    • Lisa Stack
      Lisa Stack says:

      Hi Emily!
      That is a great question. According to our Team of Doctors at CNY Fertility, there is no data to comment on regarding intra-uterine hCG and IUI. There is also no evidence that the cost would justify any potential benefit. Additionally, it could interfere with pregnancy by inhibiting the ability of sperm to survive in the uterus. Please let us know if you have any additional questions. We would love to discuss your cycle and options at any time:

  5. HGT
    HGT says:

    Hi I used to be a patient undergoing such treatment and is successful at my first attempt. Therefore I am recommending this to my sis-in-law but I forgot about the details of embryo transfer procedure. I hope you can help me on that. On the day of embryo transfer, does the patient receive in the sequence order of embryo medium first, followed by HCG and finally the blastocyst? If so, how long does each step take? Thank you in advance.

    • Editor
      Editor says:

      We appreciate your interest and questions. Since all clients and cycles are different, we would like to discuss this with your sister directly. We will be able to take into account her medical history, and treatment options. Our phone consults are free, and we would be happy to work with her. You may recommend your sister complete the following form: or call us directly at 1-800-539-9870
      We look forward to hearing from her!

  6. Dawn
    Dawn says:

    I just did a 5 day transfer of 3 embryos and my Dr is doing a study on HCG the day before the transfer. I fit his criteria for the trial. I can’t wait to see if this is the “magic” that helps!

    • Editor
      Editor says:

      Hi Heather,
      Please give our nursing staff a call today, they would be happy to help answer this for you. You can reach our office at 1-800-539-9870.
      Please let us know if you have any other questions!

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