Awwad J T, Hannoun A B, Khalil A, Younes Z M H, Ghazeeri G S
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Clin Exp Obstet Gynecol. 2012;39(4):436-9.
To evaluate the reproductive performance and safety of gonadotropin-stimulated intrauterine insemination (IUI) cycles in women at risk for ovarian hyperstimulation syndrome (OHSS) when final follicle maturation was induced using a gonadotropin-releasing hormone (GnRH) agonist.
Thirty-three women presenting with a history of cancelled ovarian stimulation for fear of OHSS, underwent repeat gonadotropin ovarian stimulation for IUI. They were all found to be at high-risk for OHSS once more, and were counseled to receive a GnRH agonist to trigger final follicle maturation before insemination. GnRH agonist trigger of ovulation (triptorelin) was given subcutaneously every 12 hours in three repeated doses: 0.3, 0.2, 0.2 mg, respectively.
Induction with the agonist was associated with a 30.3% take-home pregnancy rate and 20% miscarriage rate. Multiple pregnancy rates were 26.7%. There were no reported cases of clinically significant moderate/severe ovarian hyperstimulation syndrome.
The use of a GnRH agonist to trigger final follicle maturation in stimulated cycles of hyper responders was associated with a favorable reproductive outcome and no incidence of OHSS. The rate of multiple pregnancies nevertheless was found to be uncontrollably elevated, raising serious concerns regarding the safety of this protocol in standard clinical practice in the context of IUI.
评估对于有卵巢过度刺激综合征（OHSS）风险的女性，在使用促性腺激素释放激素（GnRH）激动剂诱导最终卵泡成熟时，促性腺激素刺激的宫腔内人工授精（IUI）周期的生殖性能和安全性。
33名因担心OHSS而取消过卵巢刺激史的女性接受了重复的促性腺激素卵巢刺激以进行IUI。她们再次被发现均为OHSS高风险人群，并接受了关于在授精前接受GnRH激动剂以触发最终卵泡成熟的咨询。排卵的GnRH激动剂触发剂（曲普瑞林）以皮下注射的方式每12小时重复给药3次，剂量分别为0.3、0.2、0.2mg。
使用激动剂诱导后，临床妊娠率为30.3%，流产率为20%。多胎妊娠率为26.7%。未报告有临床显著的中度/重度卵巢过度刺激综合征病例。
在高反应者的刺激周期中使用GnRH激动剂触发最终卵泡成熟，与良好的生殖结局相关，且无OHSS发生。然而，发现多胎妊娠率不可控地升高，这引发了对该方案在IUI标准临床实践中的安全性的严重担忧。
