Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Ioannina University School of Medicine, Ioannina, Greece.
Reprod Biomed Online. 2009 Nov;19(5):619-30. doi: 10.1016/j.rbmo.2009.09.007.
Human chorionic gonadotrophin (HCG) may substitute FSH to complete follicular growth in IVF cycles. This may be useful in the prevention of ovarian hyperstimulation syndrome. Relevant studies were identified on Medline. To evaluate outcomes, a meta-analysis of low-dose HCG-supplemented IVF cycles versus non-supplemented ones was performed with data from 435 patients undergoing IVF who were administered low-dose HCG in various agonist and antagonist protocols and from 597 conservatively treated patients who served, as control subjects. Using these published data, a decision analysis evaluated four different management strategies. Effectiveness and economic outcomes were assessed by FSH consumption, clinical pregnancy and incremental cost-effectiveness ratios. Clinical pregnancy and ovarian hyperstimulation were the main outcome measures. Nine trials published in 2002-2007 were included. From the prospective studies, in the gonadotrophin-releasing hormone antagonist group, a trend for significance in clinical pregnancy rate was evident (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.98-2.42). Ovarian hyperstimulation was less significant in the antagonist low-dose HCG protocol compared with the non-supplemented agonist protocol (OR 0.30; 95% CI 0.09-0.96). Less FSH was consumed in the low-dose HCG group but this difference was not statistically significant. Low-dose HCG supplementation may improve pregnancy rates in antagonist protocols. Overall, low-dose HCG-supplemented protocols are a cost-effective strategy.
人绒毛膜促性腺激素（HCG）可替代 FSH 完成 IVF 周期中的卵泡生长。这在预防卵巢过度刺激综合征方面可能有用。在 Medline 上确定了相关研究。为了评估结局，对低剂量 HCG 补充 IVF 周期与未补充的 IVF 周期进行了荟萃分析，共纳入 435 名接受低剂量 HCG 治疗的 IVF 患者，这些患者接受了不同激动剂和拮抗剂方案的治疗，还纳入了 597 名接受保守治疗的患者作为对照。使用这些已发表的数据，通过决策分析评估了四种不同的管理策略。通过 FSH 消耗、临床妊娠和增量成本效益比评估有效性和经济结果。临床妊娠和卵巢过度刺激是主要结局指标。纳入了 2002 年至 2007 年发表的 9 项试验。从前瞻性研究来看，在 GnRH 拮抗剂组中，临床妊娠率有显著增加的趋势（比值比 [OR]，1.54；95%置信区间 [CI]，0.98-2.42）。与未补充激动剂方案相比，拮抗剂低剂量 HCG 方案中的卵巢过度刺激程度较低（OR 0.30；95%CI 0.09-0.96）。低剂量 HCG 组的 FSH 消耗较少，但差异无统计学意义。低剂量 HCG 补充可能会提高拮抗剂方案的妊娠率。总的来说，低剂量 HCG 补充方案是一种具有成本效益的策略。
