糖皮质激素用于体外受精中预防卵巢过度刺激综合征的研究：一项前瞻性随机研究。

The administration of glucocorticoids for the prevention of ovarian hyperstimulation syndrome in in vitro fertilization: a prospective randomized study.

作者信息

Tan S L, Balen A, el Hussein E, Campbell S, Jacobs H S

机构信息

Hallam Medical Centre, King's College School of Medicine and Dentistry, London, United Kingdom.

出版信息

Fertil Steril. 1992 Aug;58(2):378-83. doi: 10.1016/s0015-0282(16)55223-6.

DOI:10.1016/s0015-0282(16)55223-6

PMID:1633906

Abstract

OBJECTIVE

To determine if the administration of glucocorticoids reduced the rate of ovarian hyperstimulation syndrome (OHSS) in high-risk patients after ovarian stimulation for in vitro fertilization (IVF).

DESIGN

Prospective randomized study.

PATIENTS

Thirty-one patients who were stimulated with human menopausal gonadotropin (hMG) after pituitary desensitization by gonadotropin-releasing hormone agonist and who developed greater than 20 follicles greater than 12 mm and/or had a serum estradiol (E2) level of greater than 10,000 pmol/L on the day of administration of human chorionic gonadotropin (hCG).

INTERVENTIONS

Patients were randomly divided into two groups. Those who were randomized to receive glucocorticoids (group A) (n = 17) were administered intravenous hydrocortisone, 100 mg, immediately after ultrasound (US)-directed oocyte recovery. Prednisolone, 10 mg three times per day, was given for 5 days starting on the day of oocyte recovery followed by prednisolone 10 mg two times a day for 3 days and 10 mg/d for 2 days. Those in group B (n = 14) did not receive any glucocorticoid treatment. In both groups, luteal support was provided by intramuscular injections of gestone 100 mg/d.

RESULTS

The two groups of patients were comparable in terms of age, duration of infertility, and total dose of hMG used. All had polycystic ovaries on US examination. On the day of hCG administration, the mean number of follicles in the two groups were 26.76 +/- 2.49 and 25.93 +/- 1.44 and the serum E2 concentration 13,404 +/- 710 and 13,915 +/- 901 pmol/L, respectively. There were no significant differences in the number of oocytes collected or in the fertilization, cleavage, and implantation rates in the two groups. The pregnancy rates per initiated cycle were 41.18% and 35.71%, respectively. Seven of the 17 patients (41.2%) who received glucocorticoids developed ovarian hyperstimulation syndrome compared with 6 of the 14 patients (42.9%) who did not receive glucocorticoids.

CONCLUSIONS

Administrations of glucocorticoids to high risk patients did not reduce the rate of OHSS after ovarian stimulation for IVF.

摘要

目的

确定体外受精（IVF）卵巢刺激后，给予糖皮质激素是否能降低高危患者卵巢过度刺激综合征（OHSS）的发生率。

设计

前瞻性随机研究。

患者

31例经促性腺激素释放激素激动剂垂体脱敏后，用人绝经期促性腺激素（hMG）进行刺激，在注射人绒毛膜促性腺激素（hCG）当天有超过20个直径大于12mm的卵泡和/或血清雌二醇（E2）水平大于10,000pmol/L的患者。

干预措施

患者随机分为两组。随机接受糖皮质激素治疗的患者（A组）（n = 17）在超声引导下取卵后立即静脉注射氢化可的松100mg。从取卵当天开始，给予泼尼松龙10mg，每日3次，共5天，随后给予泼尼松龙10mg，每日2次，共3天，然后10mg/d，共2天。B组（n = 14）未接受任何糖皮质激素治疗。两组均通过肌肉注射孕酮100mg/d进行黄体支持。

结果

两组患者在年龄、不孕时间和使用的hMG总剂量方面具有可比性。超声检查均显示有多囊卵巢。在注射hCG当天，两组的平均卵泡数分别为26.76±2.49和25.93±1.44，血清E2浓度分别为13,404±710和13,915±901pmol/L。两组在收集的卵母细胞数量、受精率、卵裂率和着床率方面无显著差异。每个启动周期的妊娠率分别为41.18%和35.71%。接受糖皮质激素治疗的17例患者中有7例（41.2%）发生卵巢过度刺激综合征，而未接受糖皮质激素治疗的14例患者中有6例（42.9%）发生。