Barmat Larry I, Chantilis Samuel J, Hurst Bradley S, Dickey Richard P
Abington Reproductive Medicine, Abington, PA 19001, USA.
Fertil Steril. 2005 Feb;83(2):321-30. doi: 10.1016/j.fertnstert.2004.06.076.
To compare the effects of oral contraceptive (OC) pill pretreatment in recombinant FSH/GnRH-antagonist versus recombinant FSH/GnRH-agonist stimulation in in vitro fertilization (IVF) patients, and to evaluate optimization of retrieval day.
Prospective, randomized, multicenter study.
Private practice and university centers.
PATIENT(S): Eighty patients undergoing IVF who met the appropriate inclusion criteria.
INTERVENTION(S): Four study centers recruited 80 patients. The OC regimen began on cycle days 2 to 4 and was discontinued on a Sunday after 14 to 28 days. The recombinant FSH regimen was begun on the following Friday. The GnRH-agonist group was treated with a long protocol; the GnRH-antagonist was initiated when the lead follicle reached 12 to 14 mm. When two follicles had reached 16 to 18 mm, hCG was administered.
MAIN OUTCOME MEASURE(S): The primary outcome measures were the number of cumulus-oocyte complexes, day of the week for oocyte retrieval, and total dose and days of stimulation of recombinant FSH. Secondary efficacy variables included pregnancy and implantation rate; serum E(2) levels on stimulation day 1; serum E(2), P, and LH levels on the day of hCG administration; follicle size on day 6 and day of hCG administration; the total days of GnRH-analogue treatment; total days on OC; total days from end of OC to oocyte retrieval; and the cycle cancellation rate.
RESULT(S): Patient outcomes were similar for the days of stimulation, total dose of gonadotropin used, two-pronuclei embryos, pregnancy (44.4% GnRH-antagonist vs. 45.0% GnRH-agonist, P=.86) and implantation rates (22.2% GnRH-antagonist vs. 26.4% GnRH-agonist, P=.71). Oral contraceptive cycle scheduling resulted in 78% and 90% of retrievals performed Monday through Friday for GnRH-antagonist and GnRH-agonist. A one day delay in OC discontinuation and recombinant FSH start would result in over 90% of oocyte retrievals occurring Monday through Friday in both groups.
CONCLUSION(S): The OC pretreatment in recombinant FSH/GnRH-antagonist protocols provides a patient-friendly regimen and can be optimized for weekday retrievals. No difference was seen in number of 2PN embryos, cryopreserved embryos, embryos transferred, implantation and pregnancy rates between the two stimulation protocols.
比较口服避孕药（OC）预处理在重组FSH/ GnRH拮抗剂与重组FSH/ GnRH激动剂刺激体外受精（IVF）患者中的效果，并评估取卵日的优化。
前瞻性、随机、多中心研究。
私人诊所和大学中心。
80例符合适当纳入标准的接受IVF的患者。
四个研究中心招募了80名患者。OC方案在月经周期第2至4天开始，14至28天后在周日停药。重组FSH方案在下周五开始。GnRH激动剂组采用长方案治疗；当主导卵泡达到12至14mm时开始使用GnRH拮抗剂。当两个卵泡达到16至18mm时，给予hCG。
主要观察指标为卵丘-卵母细胞复合体数量、取卵日、重组FSH的总剂量和刺激天数。次要疗效变量包括妊娠率和着床率；刺激第1天的血清E（2）水平；hCG给药日的血清E（2）、P和LH水平；第6天和hCG给药日的卵泡大小；GnRH类似物治疗的总天数；OC的总天数；从OC结束到取卵的总天数；以及周期取消率。
在刺激天数、使用的促性腺激素总剂量、双原核胚胎、妊娠率（GnRH拮抗剂组为44.4%，GnRH激动剂组为45.0%，P = 0.86）和着床率（GnRH拮抗剂组为22.2%，GnRH激动剂组为26.4%，P = 0.71）方面，患者的结局相似。OC周期安排导致GnRH拮抗剂组和GnRH激动剂组分别有78%和90%的取卵在周一至周五进行。OC停药和重组FSH开始延迟一天将导致两组超过90%的卵母细胞取卵在周一至周五进行。
重组FSH/ GnRH拮抗剂方案中的OC预处理提供了一种患者友好的方案，并且可以针对工作日取卵进行优化。两种刺激方案在2PN胚胎数量、冷冻胚胎数量、移植胚胎数量、着床率和妊娠率方面没有差异。
