Chang Peter L, Zeitoun Khaled M, Chan Lai-King, Thornton Melvin H, Sauer Mark V
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
J Reprod Med. 2002 Apr;47(4):253-8.
To determine if the use of a midcycle GnRH antagonist provides better clinical outcomes and lower cancellation rates in in vitro fertilization (IVF).
We examined all patients older than 40 years undergoing IVF-embryo transfer cycles between January 1999 and December 2000. Prior to June 2000, controlled ovarian stimulation in women > or = 40 years was performed with follicle stimulating hormone (FSH)/human menopausal gonadotropin (hMG) only and no GnRH agonist or antagonist (group I). After June 2000, following the release of Ganirelix in the U.S., all women > or = 40 years were stimulated with FSH/hMG + Ganirelix (group II). Outcomes of IVF cycles prior to Ganirelix were compared to results after its introduction.
Cancellation rates were significantly lower in group II (16%) as compared to group I (67%) (P < .05). In patients with oocytes retrieved, group II had a significantly higher number of recovered oocytes (7.7 +/- 0.8 vs. 5.3 +/- 0.7, P < .05). However, the number of embryos transferred, cumulative embryo scores, implantation rates and ongoing pregnancy rates did not differ significantly between groups.
Although our results are preliminary, the addition of GnRH antagonist avoids ovarian suppression at the start of controlled ovarian hyperstimulation and prevents the premature LH surge at midcycle. Thus, more patients attempting IVF undergo oocyte retrieval, although clinical outcomes may not necessarily be improved.
确定在体外受精（IVF）中使用周期中期促性腺激素释放激素（GnRH）拮抗剂是否能提供更好的临床结局并降低取消率。
我们检查了1999年1月至2000年12月期间所有年龄超过40岁接受IVF-胚胎移植周期的患者。2000年6月之前，年龄≥40岁的女性仅使用促卵泡激素（FSH）/人绝经期促性腺激素（hMG）进行控制性卵巢刺激，未使用GnRH激动剂或拮抗剂（第一组）。2000年6月之后，在美国上市了加尼瑞克之后，所有年龄≥40岁的女性均使用FSH/hMG + 加尼瑞克进行刺激（第二组）。将加尼瑞克使用之前的IVF周期结局与引入之后的结果进行比较。
与第一组（67%）相比，第二组的取消率显著更低（16%）（P < 0.05）。在取到卵母细胞的患者中，第二组回收的卵母细胞数量显著更多（7.7±0.8对5.3±0.7，P < 0.05）。然而，两组之间移植的胚胎数量、累积胚胎评分、着床率和持续妊娠率没有显著差异。
尽管我们的结果是初步的，但添加GnRH拮抗剂可避免在控制性卵巢过度刺激开始时出现卵巢抑制，并防止周期中期促黄体生成素（LH）过早峰。因此，更多尝试IVF的患者能够进行卵母细胞采集，尽管临床结局不一定会得到改善。
