Unit of Reproductive Medicine, Institution for Clinical Sciences, Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden.
Acta Obstet Gynecol Scand. 2010 Jun;89(6):828-31. doi: 10.3109/00016341003721029.
To enhance oocyte yield and pregnancy outcome in poor responder women undergoing IVF treatment, daily low dose GnRH antagonist administration was given during the late luteal phase to induce luteolysis and possibly secure a more synchronous cohort of recruitable follicles. An open extended pilot study in four Scandinavian fertility centers was done including 60 patients. Poor response was defined as when < or = 5 follicles developed in a preceding cycle following a long agonist protocol with the use of > 2000 IU FSH. GnRH antagonist (ganirelix) was given, 0.25 mg s.c. daily, from days 3 to 5 before expected start of menstruation and continued for 4-7 days. On cycle day 2-3 a starting dose of rFSH (300-400 IU/day) was given. At a leading follicle diameter of 14 mm, ganirelix administration was resumed until final oocyte maturation was induced with 10,000 IU hCG. GnRH antagonist only marginally affected the intercycle FSH rise; basal levels of FSH remained similar to those seen after 4 days of antagonist administration. The protocol effectively induced low LH levels and luteolysis, but daily administration of 350 IU rFSH (median) for 11 days only led to the collection of 3 oocytes in 49 oocyte retrievals resulting in 5 pregnancies (4 delivered). Despite GnRH antagonist administration in the late luteal phase and menstrual bleeding, FSH was not sufficiently reduced to secure a more synchronic cohort of recruitable follicles. Novel GnRH antagonists more specifically targeting FSH release may improve the stimulation results in poor responders.
为了提高接受 IVF 治疗的卵巢反应不良女性的卵母细胞产量和妊娠结局，在黄体晚期给予每日低剂量 GnRH 拮抗剂治疗，以诱导黄体溶解，并可能获得更同步的募集卵泡队列。在四个斯堪的纳维亚生育中心进行了一项开放性扩展试点研究，共纳入 60 例患者。卵巢反应不良定义为在前一个周期中，使用 > 2000 IU FSH 进行长激动剂方案后，仅发育了 < 或 = 5 个卵泡。从预计月经开始前的第 3 至 5 天开始，每天皮下给予 0.25 mg GnRH 拮抗剂（加尼瑞克），持续 4-7 天。在周期第 2-3 天，给予起始剂量 rFSH（300-400 IU/天）。当主导卵泡直径达到 14mm 时，恢复给予加尼瑞克，直到最后一个卵母细胞成熟，用 10000IU hCG 诱导。 GnRH 拮抗剂仅略微影响周期间 FSH 升高；基础 FSH 水平与拮抗剂给药后 4 天相似。该方案有效地诱导低 LH 水平和黄体溶解，但仅每天给予 350IU rFSH（中位数）11 天，导致在 49 次卵母细胞采集中仅获得 3 个卵母细胞，导致 5 例妊娠（4 例分娩）。尽管在黄体晚期和月经出血期间给予 GnRH 拮抗剂，但 FSH 并未充分降低，以确保获得更同步的募集卵泡队列。更特异性针对 FSH 释放的新型 GnRH 拮抗剂可能会改善卵巢反应不良患者的刺激效果。
