Tan S L, Balen A, el Hussein E, Mills C, Campbell S, Yovich J, Jacobs H S
Hallam Medical Centre, King's College School of Medicine and Dentistry, London, United Kingdom.
Fertil Steril. 1992 Jun;57(6):1259-64. doi: 10.1016/s0015-0282(16)55084-5.
To determine if there is an optimum time for the administration of human chorionic gonadotropin (hCG) after pituitary desensitization with gonadotropin-releasing hormone agonists (GnRH-a) has been achieved before ovarian stimulation for in vitro fertilization (IVF).
Prospective randomized study.
Two hundred forty-seven patients undergoing an IVF treatment cycle who were randomly divided into three groups.
All patients were administered subcutaneously buserelin acetate 500 micrograms/d from day 1 of the menstrual cycle. After pituitary desensitization had been achieved at least 14 days later, ovarian stimulation with human menopausal gonadotropin was commenced. Ovarian stimulation, cycle monitoring, oocyte recovery, and IVF and embryo transfer (ET) techniques were identical in all three groups. Patients in group 1 (n = 79) had hCG administered when the mean diameter of the largest follicle had reached 18 mm, at least two other follicles were greater than 14 mm, and serum estradiol (E2) levels were consistent with the number of follicles observed on ultrasound. Patients in groups 2 (n = 84) and 3 (n = 84) had hCG administered 1 day and 2 days, respectively, after the above criteria had been reached.
The mean day of hCG administration (P less than 0.01), maximum serum E2 concentration (P = 0.06), number of days of serum E2 rise (P = 0.03), and mean diameter of the largest follicle (P less than 0.0001) were significantly different. There were, however, no significant differences in the mean number of preovulatory and medium size follicles, number of oocytes recovered or embryos transferred. There were also no significant differences in the oocyte recovery, fertilization and cleavage rates, in the number of embryos frozen, or in the pregnancy rates per initiated cycle and per ET.
There is no significant advantage in the precise timing of hCG administration after pituitary desensitization with GnRH-a.
确定在体外受精（IVF）卵巢刺激前，使用促性腺激素释放激素激动剂（GnRH-a）使垂体脱敏后，给予人绒毛膜促性腺激素（hCG）是否存在最佳时间。
前瞻性随机研究。
247例接受IVF治疗周期的患者，随机分为三组。
所有患者从月经周期第1天起皮下注射醋酸布舍瑞林500微克/天。至少14天后垂体脱敏成功后，开始用人绝经期促性腺激素进行卵巢刺激。三组的卵巢刺激、周期监测、卵母细胞回收以及IVF和胚胎移植（ET）技术均相同。第1组（n = 79）患者在最大卵泡平均直径达到18 mm、至少另外两个卵泡大于14 mm且血清雌二醇（E2）水平与超声观察到的卵泡数量一致时给予hCG。第2组（n = 84）和第3组（n = 84）患者分别在达到上述标准后1天和2天给予hCG。
hCG给药的平均天数（P < 0.01）、血清E2最高浓度（P = 0.06）、血清E2上升天数（P = 0.03）以及最大卵泡平均直径（P < 0.0001）有显著差异。然而，排卵前和中等大小卵泡的平均数量、回收的卵母细胞数量或移植的胚胎数量没有显著差异。卵母细胞回收、受精和分裂率、冷冻胚胎数量、每个启动周期和每次ET的妊娠率也没有显著差异。
用GnRH-a使垂体脱敏后，hCG给药的精确时间没有显著优势。
