Colacurci Nicola, Caprio Francesca, La Verde Eugenio, Trotta Carlo, Ianniello Raffaele, Mele Daniela, De Franciscis Pasquale
Outpatient Fertility Clinic, Second University of Naples , Naples , Italy.
Gynecol Endocrinol. 2014 Oct;30(10):730-3. doi: 10.3109/09513590.2014.927856. Epub 2014 Jun 20.
A stimulation protocol mimicking the physiological pattern of FSH release may improve IVF outcome in women of advanced age. Urinary-FSH delivers a wider range of isoforms including the most acidic produced during the early follicular phase when oestradiol level is low, a common condition in women of advanced reproductive age. We hypothesized that a stimulation protocol using urinary-FSH during the early follicular phase and then shifting toward recombinant-FSH may improve oocyte quality and pregnancy rate in 35-40 years old patients in IVF program. A retrospective study was performed: after a standard down-regulation with GnRH-analogue, 115 women underwent stimulation with urinary-FSH for 6 days according to a step-down approach and then shifting to recombinant-FSH (group A), 115 women underwent a stimulation protocol with only recombinant-FSH (group B). Days of stimulation were lower in group A than in group B, a higher proportion of MII oocytes and of grade 1 embryos, higher implantation rate and pregnancy rate were observed in group A versus group B. We conclude that a sequential protocol using urinary-FSH in the early days of stimulation and subsequently recombinant-FSH may improve the IVF outcome in patients of advanced reproductive age.
模仿促卵泡激素（FSH）释放生理模式的刺激方案可能会改善高龄女性的体外受精（IVF）结局。尿促卵泡素（Urinary-FSH）可提供更广泛的同工型，包括在卵泡早期雌二醇水平较低时产生的最酸性同工型，这在高龄生育女性中是常见情况。我们假设，在卵泡早期使用尿促卵泡素然后转向重组促卵泡素的刺激方案，可能会提高35至40岁接受IVF治疗患者的卵母细胞质量和妊娠率。进行了一项回顾性研究：在用促性腺激素释放激素（GnRH）类似物进行标准降调节后，115名女性按照递减方法接受尿促卵泡素刺激6天，然后转向重组促卵泡素（A组），115名女性仅接受重组促卵泡素刺激方案（B组）。A组的刺激天数低于B组，A组观察到的MII期卵母细胞和1级胚胎比例更高，植入率和妊娠率也高于B组。我们得出结论，在刺激早期使用尿促卵泡素随后使用重组促卵泡素的序贯方案可能会改善高龄生育患者的IVF结局。
