Khalaf Y, El-Toukhy Tarek, Taylor A, Braude P
Assisted Conception Unit, 4th Floor Thomas Guy House, Guy's Hospital, St. Thomas' Street, SE1 9RT, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2002 Jul 10;103(2):146-9. doi: 10.1016/s0301-2115(02)00036-2.
To evaluate the value of increasing the gonadotrophin dose after 5 days of controlled ovarian stimulation in IVF patients who show an initial poor response to stimulation.
We identified all IVF cycles between January 1992 and March 1996 in which ovarian response after 5 days of controlled ovarian hyperstimulation (COH) with 225-300 IU per day of human menopausal gonadotrophins (hMG; Metrodin or Pergonal) was monitored by measurement of serum estradiol concentrations (n=596 patients). According to estradiol concentration, the daily dose of hMG was doubled or increased to 450 IU in 193 patients (group A) or maintained the same in 403 patients (group B). Further cycle monitoring was achieved using serial ultrasound and serum estradiol measurements.
The two groups were age-matched. Group A patients experienced a higher cancellation rate despite having a higher mean number of hMG ampoules (59.5 versus 36.2) and a longer duration of stimulation (12.2 versus 10.8 days). They achieved lower levels of serum estradiol on days 9 and 10 of stimulation, produced a lower mean number of oocytes per retrieval (5.8 versus 8.9) and had a lower clinical pregnancy rate per cycle (8.3 versus 23.4%) compared to group B. All differences were statistically significant.
The poor outcome of cycles with initial low response to COH appears not to be averted by doubling or increasing the hMG dose after 5 days of stimulation.
评估在体外受精（IVF）患者中，对初始刺激反应不佳者在控制性卵巢刺激5天后增加促性腺激素剂量的价值。
我们确定了1992年1月至1996年3月期间所有的IVF周期，这些周期中，每天使用225 - 300国际单位人绝经期促性腺激素（hMG；Metrodin或Pergonal）进行控制性卵巢过度刺激（COH）5天后，通过测量血清雌二醇浓度来监测卵巢反应（n = 596例患者）。根据雌二醇浓度，193例患者（A组）将hMG的每日剂量加倍或增加至450国际单位，403例患者（B组）维持原剂量不变。通过连续超声检查和血清雌二醇测量对周期进行进一步监测。
两组年龄匹配。A组患者尽管平均使用的hMG安瓿数量更多（59.5支对36.2支）且刺激时间更长（12.2天对10.8天），但取消率更高。与B组相比，他们在刺激第9天和第10天的血清雌二醇水平较低，每次取卵的平均卵母细胞数量较少（5.8个对8.9个），每个周期的临床妊娠率较低（8.3%对23.4%）。所有差异均具有统计学意义。
对于初始对COH反应低的周期，在刺激5天后加倍或增加hMG剂量似乎无法避免不良结局。
