在 GnRH 拮抗剂方案前采用黄体期雌二醇（E2）预处理的周期与标准长效 GnRH 激动剂方案的周期之间的体外受精/卵胞浆内单精子注射结局：一项前瞻性随机研究。
IVF/ICSI outcomes between cycles with luteal estradiol (E2) pre-treatment before GnRH antagonist protocol and standard long GnRH agonist protocol: a prospective and randomized study.
作者信息
Ye Hong, Huang Guo-ning, Zeng Ping-hong, Pei Li
机构信息
Chongqing Reproductive and Genetic Institute, Chongqing Obstetric and Gynecology Hospital, 64 Jingtang St., Yuzhong District, Chongqing 400013, China.
出版信息
J Assist Reprod Genet. 2009 Mar;26(2-3):105-11. doi: 10.1007/s10815-009-9300-3. Epub 2009 Feb 19.
OBJECTIVE
To study if luteal E(2) pre-treatment before GnRH antagonist protocol improves IVF/ICSI outcomes compared with standard long GnRH agonist protocol.
DESIGN
A prospective, randomized and controlled study.
SETTING
ART center of a state public hospital
PATIENT(S): Two hundred twenty infertile women underwent IVF/ICSI treatments.
INTERVENTION(S): Participants received oral Estradiol Valerate 4 mg/day preceding the IVF cycle from day 21 until day 2 of next cycle before GnRH antagonist protocol (E(2) pre-treatment group n=109) or received standard long GnRH agonist protocol as control group (n=111).
MAIN OUTCOME MEASURE(S): Number of oocytes collected, MII oocytes, fertilization, implantation, live birth and early pregnancy rate, and hormone profiles.
RESULT(S): E(2) pre-treatment exerted a significant suppressive effect on FSH but not LH secretion compared with basal FSH and LH levels. In E(2) pre-treatment group serum LH level was significantly higher during COH and serum P was also significantly higher on the day of HCG injection compared with control group. Five patients from E(2) pre-treatment group had elevated LH at all time (>or= 10 IU/L) and also a concomitantly high P (>1 ng/mL). Two of the five women achieved pregnancy but had early pregnancy loss. Overall, IVF/ICSI outcomes such as implantation, clinical pregnancy and live birth rates were similar between E(2) pre-treatment and control groups.
CONCLUSION(S): Luteal E(2) pre-treatment before GnRH antagonist protocol significantly increases serum LH level and incidence rate of premature LH but no significant effect is observed on implantation, clinical pregnancy, live birth and early pregnancy loss rates compared with long GnRH agonist protocol. However, more studies in large numbers of cycles are needed to confirm that increased serum LH level by E(2) pre-treatment during COH has no negative effect on the IVF/ICSI outcomes.
目的
研究在促性腺激素释放激素（GnRH）拮抗剂方案之前进行黄体期雌二醇（E₂）预处理与标准长效GnRH激动剂方案相比是否能改善体外受精/卵胞浆内单精子注射（IVF/ICSI）结局。
设计
一项前瞻性、随机对照研究。
地点
一家州立公立医院的辅助生殖技术（ART）中心
患者
220名不孕妇女接受IVF/ICSI治疗。
干预措施
在GnRH拮抗剂方案前，从第21天到下一个周期的第2天，干预组参与者在IVF周期前每天口服4毫克戊酸雌二醇（E₂预处理组，n = 109）；或接受标准长效GnRH激动剂方案作为对照组（n = 111）。
主要观察指标
采集的卵母细胞数量、成熟卵母细胞（MII）、受精、着床、活产和早期妊娠率，以及激素水平。
结果
与基础促卵泡生成素（FSH）和促黄体生成素（LH）水平相比，E₂预处理对FSH分泌有显著抑制作用，但对LH分泌无显著抑制作用。与对照组相比，E₂预处理组在控制性卵巢刺激（COH）期间血清LH水平显著更高，在注射人绒毛膜促性腺激素（HCG）当天血清孕酮（P）水平也显著更高。E₂预处理组有5名患者LH一直升高（≥10 IU/L），且P也同时升高（>1 ng/mL）。这5名女性中有2名怀孕，但发生了早期妊娠丢失。总体而言，E₂预处理组和对照组之间的IVF/ICSI结局，如着床、临床妊娠和活产率相似。
结论
与长效GnRH激动剂方案相比，在GnRH拮抗剂方案之前进行黄体期E₂预处理可显著提高血清LH水平和过早LH发生率，但对着床、临床妊娠、活产和早期妊娠丢失率无显著影响。然而，需要更多大量周期的研究来证实COH期间E₂预处理导致的血清LH水平升高对IVF/ICSI结局无负面影响。
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