Malmusi Stefania, La Marca Antonio, Giulini Simone, Xella Susanna, Tagliasacchi Daniela, Marsella Tiziana, Volpe Annibale
Institute of Obstetrics and Gynecology, Policlinico of Modena, Modena University, Modena, Italy.
Fertil Steril. 2005 Aug;84(2):402-6. doi: 10.1016/j.fertnstert.2005.01.139.
To compare the efficacy of flare-up and GnRH-antagonist treatment in poor-responder patients.
Randomized prospective study.
Assisted reproduction center.
PATIENT(S): Fifty-five poor-responder patients undergoing intracytoplasmic sperm injection (ICSI).
INTERVENTION(S): Thirty patients received GnRH agonist on the 1st day of menstruation, followed by exogenous gonadotropins from the 2nd day. Twenty-five patients received exogenous gonadotropins starting on the second day of menstruation, followed by GnRH antagonist when the leading follicle reached 14 mm in diameter.
MAIN OUTCOME MEASURE(S): The total dose of FSH administered during the ovarian stimulation, as well as the number of mature oocytes retrieved, embryo quality, fertilization, implantation, and pregnancy rates were evaluated.
RESULT(S): The number of ampules and units of FSH administered were significantly less in the flare-up than in the antagonistic group. The numbers of mature oocytes retrieved and of top-quality embryos transferred were significantly greater in the flare-up than in the GnRH-antagonist group. The fertilization rate (84% vs. 63%) was significantly higher in the flare-up than in the GnRH-antagonist group. The implantation and pregnancy rate were similar in the two groups.
CONCLUSION(S): The flare-up protocol appears to be more effective than the GnRH-antagonist protocol in terms of mature oocytes retrieved, fertilization rate, and top-quality embryos transferred in poor-responder patients.
比较激动剂方案和促性腺激素释放激素（GnRH）拮抗剂方案对卵巢低反应患者的疗效。
随机前瞻性研究。
辅助生殖中心。
55例接受卵胞浆内单精子注射（ICSI）的卵巢低反应患者。
30例患者在月经第1天接受GnRH激动剂治疗，从第2天开始使用外源性促性腺激素。25例患者从月经第2天开始使用外源性促性腺激素，当主导卵泡直径达到14 mm时开始使用GnRH拮抗剂。
评估卵巢刺激期间促卵泡激素（FSH）的总给药剂量，以及获取的成熟卵母细胞数量、胚胎质量、受精率、着床率和妊娠率。
激动剂方案组FSH的安瓿数和单位数显著少于拮抗剂方案组。激动剂方案组获取的成熟卵母细胞数量和移植的优质胚胎数量显著多于GnRH拮抗剂方案组。激动剂方案组的受精率（84%对63%）显著高于GnRH拮抗剂方案组。两组的着床率和妊娠率相似。
在卵巢低反应患者中，就获取的成熟卵母细胞数量、受精率和移植的优质胚胎数量而言，激动剂方案似乎比GnRH拮抗剂方案更有效。
