Department of Obstetrics and Gynecology, University of Montreal, Montreal, Canada.
J Assist Reprod Genet. 2013 Jun;30(6):773-8. doi: 10.1007/s10815-013-0016-z. Epub 2013 May 30.
To evaluate the outcomes in the conversion of high-response gonadotropin intrauterine insemination (IUI) cycles to "rescue" in vitro fertilization (IVF) using a Gonadotropin-Releasing Hormone (GnRH) antagonist, with regards to implantation rates, pregnancy rates, cost, and ovarian hyperstimulation syndrome (OHSS) as compared to matched, hyper-responder, IVF controls.
This prospective cohort study was conducted between January 2007 and December 2009 at our institution. In order to decrease high-order multiple pregnancy, minimize the incidence of OHSS, and avoid cycle cancellation, high-response stimulated-IUI patients opted to convert to "rescue" IVF using the GnRH antagonist cetrorelix acetate. We then compared their clinical outcomes with matched patients from high-response IVF cycles of the standard long mid-luteal GnRH agonist protocol (14 or more collected oocytes). Only cases of conventional IVF without intra-cytoplasmic sperm injection (ICSI) were included in the control group.
Out of 184 patients undergoing stimulated-IUI cycles with gonadotropins, 87 patients developed a hyper-response, and 20 opted to convert to "rescue" IVF. These patients were compared with 157 matched, hyper responder IVF controls from our registry. The implantation rate was 25.6 % in the "rescue" IVF group and 20.7 % in the control IVF group (p < 0.0047). The ongoing clinical pregnancy rate per embryo transfer was 45.0 % and 33.6 % in the "rescue" IVF and the control IVF groups, respectively (p < 0.0001). The mean duration of stimulation was comparable between cohorts (10.0 vs.10.4 days, p = 0.6324). The mean dose of gonadotropin used per cycle was higher in the control group, 2664 international units (IU) of follicle stimulation hormone (FSH) compared to 1450 IU of FSH in the "rescue" IVF group (p < 0.0001). The incidence of severe OHSS is also higher in the control group, 5.1 % versus no cases in the "rescue" IVF group (p < 0.0001).
Our study demonstrates that conversion of high-response gonadotropin-IUI cycles to "rescue" IVF using a GnRH antagonist is a cost-effective strategy that produces better results than regular IVF with relatively minimal morbidity, and shorter duration to achieve pregnancy. Implantation and ongoing clinical pregnancy rates tend to be higher than those from hyper-responder regular IVF patients.
评估使用促性腺激素释放激素（GnRH）拮抗剂将高反应性促性腺激素宫腔内人工授精（IUI）周期转换为“挽救”体外受精（IVF）的结局，比较着床率、妊娠率、成本和卵巢过度刺激综合征（OHSS），与匹配的高反应性 IVF 对照组相比。
这项前瞻性队列研究于 2007 年 1 月至 2009 年 12 月在我院进行。为了降低多胎妊娠的发生率，最大限度地降低 OHSS 的发生率，避免取消周期，高反应性刺激 IUI 患者选择使用 GnRH 拮抗剂醋酸西曲瑞克转换为“挽救”IVF。然后，我们将他们的临床结局与高反应性 IVF 周期（14 个或更多采集的卵母细胞）的标准长中黄体 GnRH 激动剂方案的匹配患者进行比较。仅包括对照组中无胞浆内精子注射（ICSI）的常规 IVF 病例。
在接受促性腺激素刺激 IUI 周期的 184 名患者中，87 名患者出现高反应，20 名患者选择转换为“挽救”IVF。这些患者与来自我们注册处的 157 名匹配的高反应性 IVF 对照组进行了比较。“挽救”IVF 组的着床率为 25.6%，对照组的着床率为 20.7%（p<0.0047）。每个胚胎移植的持续临床妊娠率分别为“挽救”IVF 组的 45.0%和对照组的 33.6%（p<0.0001）。两组的平均刺激持续时间相似（10.0 天对 10.4 天，p=0.6324）。对照组每周期使用的促性腺激素剂量较高，卵泡刺激素（FSH）为 2664 国际单位（IU），而“挽救”IVF 组为 1450IU FSH（p<0.0001）。对照组中严重 OHSS 的发生率也较高，为 5.1%，而“挽救”IVF 组无病例（p<0.0001）。
我们的研究表明，使用 GnRH 拮抗剂将高反应性促性腺激素 IUI 周期转换为“挽救”IVF 是一种具有成本效益的策略，与常规 IVF 相比，它产生了更好的结果，相对较低的发病率，并且妊娠时间更短。着床率和持续临床妊娠率往往高于高反应性常规 IVF 患者。
