Lainas Trifon, Zorzovilis John, Petsas George, Stavropoulou Georgia, Cazlaris Haris, Daskalaki Vassiliki, Lainas George, Alexopoulou Efthymia
Iatriki Erevna-IVF Unit, Athens, Greece.
Hum Reprod. 2005 Sep;20(9):2426-33. doi: 10.1093/humrep/dei106. Epub 2005 Jun 9.
The purpose of the study was to assess ongoing pregnancy rates across groups of patients treated by IVF, which were defined according to criteria aimed at the prevention of premature LH surge and used for initiating GnRH antagonist.
This is a prospective observational cohort study. During the last 3 years, in IVF-ICSI patients undergoing controlled ovarian stimulation (COS) with the antagonist protocol, the antagonist administration was initiated according to at least one of the following patient-specific criteria: (i) at least one follicle measuring >14 mm; (ii) estradiol levels >600 pg/ml; and (iii) LH levels >10 IU/l. Based upon these criteria, 208 cases of normal responders were analysed and categorized into three groups according to the starting day of the regimen: group D4 (n = 40) for day 4, group D5 (n = 98) for day 5 and group D6 (n = 70) for day 6. The main outcome measure was the ongoing pregnancy rate per started cycle.
The total number of patients in the D4 and D5 groups (138 out of 208), who received the antagonist earlier, was considerably larger compared with that of D6 (70 out of 208). Ongoing pregnancy rates were 37.5, 34.7 and 18.6% for groups D4, D5 and D6, respectively. Patients who initiated the GnRH antagonist on days 4 and 5 had statistically significant higher pregnancy rates compared with day 6. Rapid response, causing earlier antagonist administration initiation, according to the proposed criteria for the prevention of premature LH surges, and the absence of premature luteinization, as evidenced by normal progesterone levels on HCG day, were found to be independent positive predictive factors for favourable IVF outcome.
The employment of an algorithm of criteria, aimed at the prevention of premature LH surges in a flexible antagonist protocol, resulted in antagonist initiation earlier than on stimulation day 6 in a significant proportion of patients. In those patients, a higher pregnancy rate was observed.
本研究的目的是评估接受体外受精（IVF）治疗的不同患者组的持续妊娠率，这些患者组是根据旨在预防过早促黄体生成素（LH）峰的标准定义的，并用于启动促性腺激素释放激素（GnRH）拮抗剂。
这是一项前瞻性观察队列研究。在过去3年中，对于接受拮抗剂方案控制性卵巢刺激（COS）的IVF-卵胞浆内单精子注射（ICSI）患者，根据至少以下一项患者特异性标准开始给予拮抗剂：（i）至少有一个卵泡直径>14 mm；（ii）雌二醇水平>600 pg/ml；（iii）LH水平>10 IU/l。基于这些标准，分析了208例正常反应者，并根据方案开始日将其分为三组：第4天组（n = 40）、第5天组（n = 98）和第6天组（n = 70）。主要结局指标是每个启动周期的持续妊娠率。
与第6天组（208例中的70例）相比，较早接受拮抗剂的第4天和第5天组患者总数（208例中的138例）明显更多。第4天、第5天和第6天组的持续妊娠率分别为37.5%、34.7%和18.6%。在第4天和第5天开始使用GnRH拮抗剂的患者与第6天相比，妊娠率具有统计学显著更高。根据所提出的预防过早LH峰的标准，快速反应导致更早开始给予拮抗剂，且人绒毛膜促性腺激素（HCG）日孕酮水平正常证明无过早黄素化，这些被发现是体外受精良好结局的独立阳性预测因素。
在灵活的拮抗剂方案中采用旨在预防过早LH峰的标准算法，导致在相当比例的患者中拮抗剂启动早于刺激第6天。在这些患者中，观察到更高的妊娠率。
