Sudik R, Fliess F R, Kunkel S
Klinik für Gynäkologie und Geburtshilfe, Wilhelm-Pieck-Universität Rostock.
Zentralbl Gynakol. 1989;111(9):567-80.
144 patients were treated by 5 different stimulation protocols in the IVF-program of the University Women's Hospital Rostock (Clomiphene/hCG, Clomiphene/Anthrogon/hCG, Pergonal/hCG, Anthrogon/hCG, Folistiman/hCG). Estradiol-17 beta and progesterone were determined during the follicular phase of 172 cycles by RIA. The results were compared between the treatment groups by means of Student's t-test or Mann-Whitney's nonparametric test. Additionally, in 37 cycles prolactin was determined. The levels of estradiol-17 beta in all treated groups were higher as compared with spontaneous cycles. Between the groups statistically significant differences were found in start and velocity of E2-rise, in the average level of E2, and in the level of preovulatory peaks. The latent phase of stimulation was significantly longer in patients treated with pergonal than in Anthrogon treated patients. Moreover, in the Anthrogon group the rate of "high responder" was higher. On average, in patients with a very fast growth rate of estradiol-17 beta (greater than 1.9 nmol/l) during the late follicular phase the percentage of less mature oocytes was increased after follicular puncture. The levels of progesterone started to rise in all groups between day-2 and -1 (day 0: day of LH-peak). On day 0, patients with Pergonal and Anthrogon had the significantly highest level. Levels above the 1s-range occurred in 12 patients during the follicular phase. This elevation of progesterone took place in 3 patients without any rise of basal LH-levels. 80.4% of 37 patients investigated were found to have prolactin levels above 500 mE/l during the late follicular phase. This transient hyperprolactinemia correlated with the rise of estradiol levels and continued during the early and mid luteal phase. Hence preventive administration of bromocryptine appears to be advisable in cycles stimulated with gonadotropins.
在罗斯托克大学妇女医院的体外受精项目中，144名患者接受了5种不同的刺激方案治疗（克罗米芬/人绒毛膜促性腺激素、克罗米芬/安特贡/人绒毛膜促性腺激素、果纳芬/人绒毛膜促性腺激素、安特贡/人绒毛膜促性腺激素、福丽施坦/人绒毛膜促性腺激素）。在172个周期的卵泡期，通过放射免疫分析法测定了雌二醇-17β和孕酮。通过学生t检验或曼-惠特尼非参数检验对各治疗组的结果进行比较。此外，在37个周期中测定了催乳素。与自然周期相比，所有治疗组的雌二醇-17β水平均较高。在各治疗组之间，发现雌二醇升高的起始时间和速度、雌二醇的平均水平以及排卵前峰值水平存在统计学显著差异。使用果纳芬治疗的患者刺激的潜伏期明显长于使用安特贡治疗的患者。此外，安特贡组“高反应者”的比例更高。平均而言，在卵泡晚期雌二醇-17β生长速度非常快（大于1.9 nmol/l）的患者中，卵泡穿刺后未成熟卵母细胞的百分比增加。所有组的孕酮水平在第2天至第1天（第0天：促黄体生成素峰值日）开始升高。在第0天，使用果纳芬和安特贡的患者孕酮水平显著最高。在卵泡期，12名患者的孕酮水平高于正常范围。3名患者在基础促黄体生成素水平未升高的情况下出现了孕酮升高。在37名接受调查的患者中，80.4%在卵泡晚期催乳素水平高于500 mE/l。这种短暂的高催乳素血症与雌二醇水平的升高相关，并在黄体早期和中期持续存在。因此，在使用促性腺激素刺激的周期中，预防性给予溴隐亭似乎是可取的。
