MacLachlan V, Besanko M, O'Shea F, Wade H, Wood C, Trounson A, Healy D L
Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
N Engl J Med. 1989 May 11;320(19):1233-7. doi: 10.1056/NEJM198905113201902.
Treatment with clomiphene citrate and human menopausal gonadotropin (HMG) is often used to induce folliculogenesis before in vitro fertilization, but not all women have an adequate response. It has been hypothesized that abnormally high levels of luteinizing hormone (LH) may contribute to the reduced folliculogenesis. We therefore performed a controlled, open trial in which treatment with buserelin, an agonist of luteinizing hormone-releasing hormone citrate and HMG in 44 consecutive women in whom no oocytes or only one had been produced by standard treatment with clomiphene and HMG. Twenty-nine women received buserelin with HMG, and 15 received clomiphene citrate with HMG. The median number of oocytes per patient recovered from those who received buserelin with HMG was 4 (range, 0 to 19), as compared with 0 (range, 0 to 5) in those who received clomiphene citrate with HMG. The fertilization rates of oocytes recovered from both groups of patients were similar (75.8 percent and 76.5 percent, respectively). Fifty-four percent of patients given buserelin with HMG underwent triple-embryo transfer, as compared with 13 percent of those given clomiphene citrate with HMG. Pregnancy (n = 3) occurred only among the patients receiving buserelin with HMG. In the buserelin-HMG group, significantly fewer oocytes were recovered from patients with occult ovarian failure (infertility and elevated follicular-phase levels of follicle-stimulating hormone, with regular menses) (median, 1; range, 0 to 4) than from those with other causes of infertility (median, 8; range, 0 to 19). Our data suggest that, except in women with occult ovarian failure, buserelin and HMG improve embryologic and clinical outcomes in patients with previously unsatisfactory stimulation of the ovaries for in vitro fertilization.
枸橼酸氯米芬与人绝经期促性腺激素（HMG）联合治疗常用于体外受精前诱导卵泡生成，但并非所有女性都有足够的反应。据推测，促黄体生成素（LH）水平异常升高可能导致卵泡生成减少。因此，我们进行了一项对照开放试验，对44例连续的女性患者使用布舍瑞林（一种促黄体生成素释放激素激动剂）联合枸橼酸氯米芬和HMG进行治疗，这些女性患者采用标准的枸橼酸氯米芬和HMG治疗未产生卵母细胞或仅产生了1个卵母细胞。29例女性接受布舍瑞林联合HMG治疗，15例接受枸橼酸氯米芬联合HMG治疗。接受布舍瑞林联合HMG治疗的患者，每位患者回收的卵母细胞中位数为4个（范围为0至19个），而接受枸橼酸氯米芬联合HMG治疗的患者为0个（范围为0至5个）。两组患者回收的卵母细胞受精率相似（分别为75.8%和76.5%）。接受布舍瑞林联合HMG治疗的患者中有54%进行了三胚胎移植，而接受枸橼酸氯米芬联合HMG治疗的患者中这一比例为13%。妊娠（n = 3）仅发生在接受布舍瑞林联合HMG治疗的患者中。在布舍瑞林-HMG组中，隐匿性卵巢功能不全（不孕且卵泡期卵泡刺激素水平升高，月经规律）患者回收的卵母细胞明显少于其他不孕原因患者（中位数分别为1个，范围为0至4个；中位数分别为8个，范围为0至19个）。我们的数据表明，除隐匿性卵巢功能不全的女性外，布舍瑞林和HMG可改善先前卵巢刺激效果不佳的体外受精患者的胚胎学和临床结局。
