Loutradis D, Elsheikh A, Kallianidis K, Drakakis P, Stefanidis K, Milingos S, Michalas S
1st Department of Obstetrics and Gynecology, Alexandra University Hospital, Athens, Greece.
Arch Gynecol Obstet. 2004 Dec;270(4):223-6. doi: 10.1007/s00404-003-0544-3. Epub 2003 Sep 12.
Improving pregnancy rates in intricate cases of ovarian stimulation remains a challenge during IVF and intracytoplasmic sperm injection (ICSI). Different protocols of ovulation induction have been proposed.
The short protocol of ovarian stimulation using recombinant follicle-stimulating hormone (rFSH) with or without the use of luteinizing hormone (LH) in IVF or ICSI outcome in patients with many failed attempts and maternity age > or = 37 years was investigated. The prognostic significance of high but normal values of day 3 serum FSH concentrations was also evaluated.
Results show that FSH levels of >9 mIU/ml are associated with poor results even with the use of human menopausal gonadotrophin (HMG). Results were generally comparable when rFSH was used alone or in combination with HMG, except for the quality and the number of embryos transferred, the later being better in the rFSH + HMG group.
In conclusion intricate cases have good chances for achieving a pregnancy using the short protocol and the outcome is further improved when LH is added from the beginning of ovarian stimulation. A slight elevation of day 3 FSH seems to be a strong prognostic factor for a poor outcome.
在体外受精（IVF）和卵胞浆内单精子注射（ICSI）过程中，提高复杂卵巢刺激病例的妊娠率仍然是一项挑战。人们已经提出了不同的排卵诱导方案。
研究了在多次尝试失败且产妇年龄≥37岁的患者中，在IVF或ICSI中使用重组促卵泡激素（rFSH）加或不加促黄体生成素（LH）进行卵巢刺激的短方案的效果。还评估了第3天血清FSH浓度高但正常时的预后意义。
结果表明，即使使用人绝经期促性腺激素（HMG），FSH水平>9 mIU/ml也与不良结果相关。单独使用rFSH或与HMG联合使用时，结果总体相当，但胚胎移植的质量和数量除外，rFSH+HMG组的后者更好。
总之，复杂病例使用短方案有良好的妊娠机会，并且从卵巢刺激开始就添加LH时，结果会进一步改善。第3天FSH的轻微升高似乎是预后不良的一个强有力的预测因素。
