Humaidan P, Bredkjaer H Ejdrup, Bungum L, Bungum M, Grøndahl M L, Westergaard L, Andersen C Yding
The Fertility Clinic, Viborg Hospital (Skive), Denmark.
Hum Reprod. 2005 May;20(5):1213-20. doi: 10.1093/humrep/deh765. Epub 2005 Mar 10.
We aimed to determine the efficacy of ovarian hyperstimulation protocols employing a GnRH antagonist to prevent a premature LH rise allowing final oocyte maturation and ovulation to be induced by a single bolus of either a GnRH agonist or hCG.
A total of 122 normogonadotrophic patients following a flexible antagonist protocol was stimulated with recombinant human FSH and prospectively randomized (sealed envelopes) to ovulation induction with a single bolus of either 0.5 mg buserelin s.c. (n = 55) or 10,000 IU of hCG (n = 67). A maximum of two embryos was transferred. Luteal support consisted of micronized progesterone vaginally, 90 mg a day, and estradiol, 4 mg a day per os.
Ovulation was induced with GnRH agonist in 55 patients and hCG in 67 patients. Significantly more metaphase II (MII) oocytes were retrieved in the GnRH agonist group (P < 0.02). Significantly higher levels of LH and FSH (P < 0.001) and significantly lower levels of progesterone and estradiol (P < 0.001) were seen in the GnRH agonist group during the luteal phase. The implantation rate, 33/97 versus 3/89 (P < 0.001), clinical pregnancy rate, 36 versus 6% (P = 0.002), and rate of early pregnancy loss, 4% versus 79% (P = 0.005), were significantly in favour of hCG.
Ovulation induction with a GnRH agonist resulted in significantly more MII oocytes. However, a significantly lower implantation rate and clinical pregnancy rate in addition to a significantly higher rate of early pregnancy loss was seen in the GnRH agonist group, most probably due to a luteal phase deficiency.
我们旨在确定使用促性腺激素释放激素（GnRH）拮抗剂的卵巢过度刺激方案的疗效，以防止过早出现促黄体生成素（LH）峰，从而能够通过单次注射GnRH激动剂或人绒毛膜促性腺激素（hCG）来诱导最终的卵母细胞成熟和排卵。
总共122名遵循灵活拮抗剂方案的正常促性腺激素水平患者接受重组人促卵泡生成素（FSH）刺激，并前瞻性随机分组（密封信封），分别接受单次皮下注射0.5mg布舍瑞林（n = 55）或10000IU hCG（n = 67）进行排卵诱导。最多移植两个胚胎。黄体支持包括每天经阴道给予90mg微粒化孕酮和每天口服4mg雌二醇。
55名患者使用GnRH激动剂诱导排卵，67名患者使用hCG诱导排卵。GnRH激动剂组回收的中期II（MII）卵母细胞明显更多（P < 0.02）。在黄体期，GnRH激动剂组的LH和FSH水平显著更高（P < 0.001），而孕酮和雌二醇水平显著更低（P < 0.001）。植入率分别为33/97和3/89（P < 0.001），临床妊娠率分别为36%和6%（P = 0.002），早期妊娠丢失率分别为4%和79%（P = 0.005），均显著有利于hCG组。
使用GnRH激动剂诱导排卵可产生明显更多的MII卵母细胞。然而，GnRH激动剂组的植入率和临床妊娠率显著更低，且早期妊娠丢失率显著更高，很可能是由于黄体期缺陷所致。
