Academic Department of Biomedicine & Prevention, Section of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.
Arch Gynecol Obstet. 2012 Nov;286(5):1291-7. doi: 10.1007/s00404-012-2430-3. Epub 2012 Jun 24.
To assess the differences in follicular development comparing two sequential low-dose step-up and step-down protocols (A: 37.5 IU/day, B: 75 IU/day) with a step-down protocol (C: 150 IU/day) using recombinant human follicle stimulating hormone (rFSH) in women with polycystic ovarian syndrome (PCOS).
In this prospective observational comparative study, 60 PCOS women were treated with one of the three protocols for only one cycle.
RESULT(S): Monofollicular development was similar among the three protocols but the total number of follicles >10 mm in diameter was significantly lower in group A (1 ± 0.94 vs 6.3 ± 2.45 vs 8.6 ± 4.45; P = 0.001 A vs B; P < 0.001 A vs C). Cycle cancellation rate was higher in protocol A and in protocol C because of no ovarian response and excessive multifollicular development, respectively. The total amount of rFSH for complete cycle was significantly lower in protocol A (P = 0.02 A vs B; P = 0.007 A vs C). No mild or severe hyperstimulation syndrome (OHSS) was observed.
CONCLUSION(S): A and B protocols seem to be a more effective approach than the step-down protocol. In both groups, the pregnancy rate for started cycle was the same. Protocol A has allowed the development of a lower number of small follicles, single pregnancies, but an excessive number of cancelled cycles occurred. In protocol B no cycle cancellation occurred, though the total rFSH dosage was significantly higher than the protocol A and two twin pregnancies were observed.
比较两种序贯低剂量递增-递减方案（A：37.5IU/天，B：75IU/天）与递减方案（C：150IU/天）使用重组人卵泡刺激素（rFSH）治疗多囊卵巢综合征（PCOS）妇女卵泡发育的差异。
在这项前瞻性观察性比较研究中，60 名 PCOS 妇女仅接受了这三种方案中的一种方案进行一个周期的治疗。
三种方案中单卵泡发育相似，但 A 组的>10mm 直径卵泡总数明显较少（1±0.94 对 6.3±2.45 对 8.6±4.45；P=0.001 A 对 B；P<0.001 A 对 C）。由于卵巢无反应和过度多卵泡发育，方案 A 和方案 C 的取消率较高。方案 A 中完成整个周期所需的 rFSH 总量明显较低（P=0.02 A 对 B；P=0.007 A 对 C）。未观察到轻度或重度卵巢过度刺激综合征（OHSS）。
方案 A 和 B 似乎比递减方案更有效。在这两组中，起始周期的妊娠率相同。方案 A 允许形成较少数量的小卵泡和单胎妊娠，但取消的周期数量过多。在方案 B 中，虽然总 rFSH 剂量明显高于方案 A，但没有取消周期，且观察到两例双胞胎妊娠。
