Griesinger G, Diedrich K, Tarlatzis B C, Kolibianakis E M
Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
Reprod Biomed Online. 2006 Nov;13(5):628-38. doi: 10.1016/s1472-6483(10)60652-9.
This article is a systematic review of the literature on utilization of gonadotrophin-releasing hormone antagonists (GnRH-ant) for ovarian stimulation for IVF in special patient groups. Summarized by meta-analysis are the data from randomized controlled trials (RCT) in which GnRH-agonist (GnRH-a) and GnRH-ant were compared (eight RCT for poor response, four RCT for PCOS). Also reviewed are the data from two RCT and 13 retrospective or observational trials in which patients at risk of ovarian hyperstimulation syndrome (OHSS) were triggered with GnRH-agonist instead of HCG. For poor responders, no differences in clinical outcomes were found, except a significantly higher number of cumulus-oocyte complexes in GnRH-antagonist multiple dose protocol as compared to GnRH-agonist long protocol (P=0.05). For PCOS patients, no differences in outcomes were found, except a significantly shorter duration of stimulation, when GnRH-antagonist multiple dose protocol and GnRH-agonist long protocol are compared (P<0.01). However, sample sizes are still small and power to detect subtle differences is therefore limited. For OHSS risk patients triggered with GnRH-agonist, reports on the efficacy of this measure vary in the literature. GnRH-agonist triggering appears to be associated with a reduction in the incidence of mild and moderate OHSS. For prevention of severe OHSS, as yet, only very limited evidence is available.
本文是一篇关于促性腺激素释放激素拮抗剂（GnRH-ant）在特殊患者群体体外受精（IVF）卵巢刺激中应用的文献系统综述。通过荟萃分析总结了比较GnRH激动剂（GnRH-a）和GnRH拮抗剂的随机对照试验（RCT）数据（8项针对反应不良患者的RCT，4项针对多囊卵巢综合征（PCOS）患者的RCT）。还回顾了两项RCT以及13项回顾性或观察性试验的数据，这些试验中卵巢过度刺激综合征（OHSS）风险患者采用GnRH激动剂而非人绒毛膜促性腺激素（HCG）进行扳机注射。对于反应不良患者，未发现临床结局存在差异，但与GnRH激动剂长方案相比，GnRH拮抗剂多剂量方案中的卵丘-卵母细胞复合体数量显著更多（P=0.05）。对于PCOS患者，当比较GnRH拮抗剂多剂量方案和GnRH激动剂长方案时，除了刺激持续时间显著缩短外（P<0.01），未发现结局存在差异。然而，样本量仍然较小，因此检测细微差异的效能有限。对于采用GnRH激动剂进行扳机注射的OHSS风险患者，该措施疗效的文献报道各不相同。GnRH激动剂扳机注射似乎与轻、中度OHSS发生率降低相关。至于预防重度OHSS，目前仅有非常有限的证据。
