Roulier Roger, Chabert-Orsini Véronique, Sitri Marie-Christine, Barry Bernard, Terriou P
Institut de Médecine de la Reproduction, 6 rue Rocca, 13417 Marseille, France.
Reprod Biomed Online. 2003 Sep;7(2):185-9. doi: 10.1016/s1472-6483(10)61749-x.
The objective of this study was to compare, in a centre with previous experience of gonadotrophin-releasing hormone (GnRH) antagonist use, single administration of a GnRH antagonist [cetrorelix (Cetrotide) 3 mg] with a single administration of a GnRH agonist [Decapeptyl Retard 3.75 mg] in patients undergoing assisted reproduction treatment (n = 307 and 364 respectively). GnRH agonist was administered on the first day of menses, while cetrorelix was administered when the largest follicle reached 14 mm. Ovarian stimulation was performed with recombinant human FSH (r-hFSH; 150-225 IU/day). Human chorionic gonadotrophin (HCG, 10,000 IU) was administered when at least two follicles reached a mean diameter > or =18 mm. Over 90% of patients in both groups reached the criteria for HCG administration and underwent oocyte retrieval and embryo transfer. Duration of FSH therapy (9.95 versus 11.25 days) and cumulative dose of r-hFSH (1604 versus 1980 IU) were significantly reduced (P < 0.01) in the cetrorelix 3 mg group. The number of oocytes retrieved was lower (8.5 versus 11.2; P < 0.01) with cetrorelix, but the number of embryos replaced was similar (2.2 versus 2.3; NS). The pregnancy rates per oocyte retrieval were the same, 24.5%, in the antagonist and agonist groups. This study indicates that although fewer oocytes are recovered, similar pregnancy rates can be achieved with a GnRH antagonist compared with a GnRH agonist. Additionally, a single dose of 3 mg cetrorelix was administered in 84% of patients, thus being simpler and more convenient for patients. Cetrorelix 3 mg may thus be proposed as a first choice for preventing both a premature LH surge and detrimental rises in LH during ovarian stimulation prior to assisted reproduction treatment.
本研究的目的是在一个有使用促性腺激素释放激素（GnRH）拮抗剂经验的中心，比较在接受辅助生殖治疗的患者中（分别为307例和364例），单次给予GnRH拮抗剂[西曲瑞克（Cetrotide）3毫克]与单次给予GnRH激动剂[长效曲普瑞林3.75毫克]的效果。GnRH激动剂在月经第一天给药，而西曲瑞克在最大卵泡达到14毫米时给药。采用重组人促卵泡生成素（r-hFSH；150 - 225国际单位/天）进行卵巢刺激。当至少两个卵泡平均直径≥18毫米时，给予人绒毛膜促性腺激素（HCG，10,000国际单位）。两组中超过90%的患者达到了HCG给药标准，并接受了卵母细胞采集和胚胎移植。西曲瑞克3毫克组的FSH治疗持续时间（9.95天对11.25天）和r-hFSH累积剂量（1604国际单位对1980国际单位）显著降低（P < 0.01）。使用西曲瑞克采集的卵母细胞数量较少（8.5个对11.2个；P < 0.01），但移植的胚胎数量相似（2.2个对2.3个；无显著差异）。拮抗剂组和激动剂组每次卵母细胞采集的妊娠率相同，均为24.5%。本研究表明，尽管采集的卵母细胞较少，但与GnRH激动剂相比，GnRH拮抗剂可实现相似的妊娠率。此外，84%的患者接受了单次3毫克西曲瑞克给药，因此对患者来说更简单、更方便。因此，3毫克西曲瑞克可被推荐为在辅助生殖治疗前卵巢刺激期间预防过早LH峰和LH有害升高的首选药物。
