Tabata Chisa, Fujiwara Toshihiro, Sugawa Miki, Noma Momo, Onoue Hiroki, Kusumi Maki, Watanabe Noriko, Kurosawa Takako, Tsutsumi Osamu
Sanno Hospital, Center of Reproduction and Gynecologic Endoscopic Surgery, 8-10-16 Akasaka Minatoku, Tokyo Japan.
Reprod Med Biol. 2015;14(1):5-9. doi: 10.1007/s12522-014-0186-0. Epub 2014 Jul 11.
To compare the embryo outcomes of in vitro fertilization/intra-cytoplasmic sperm injection with a gonadotropin-releasing hormone (GnRH) antagonist protocol with follicle stimulating hormone (FSH) and with human menopausal gonadotropin (hMG).
We performed a retrospective cohort study in 465 patients. Stimulation was started by daily FSH injection, and either FSH was continued (FSH alone group) or hMG was administrated (FSH-hMG group) after administration of a GnRH antagonist. Primary outcomes were the embryo profile (number of retrieved, mature, and fertilized eggs, and morphologically good embryos on day 3) and endocrine profile. Secondary outcomes were the doses and durations of gonadotropin. Data were stratified by the patients' age into two groups: <35 years and ≥35 years.
In patients aged <35 years, the number of retrieved oocytes in the FSH alone group was significantly increased than that in the FSH-hMG group (13.7 vs 9.2, = 0.04), while there was no difference at other age groups. The FSH-hMG group required a significantly greater amount of gonadotropins at any age (all ages, < 0.001; <35 years, = 0.013; ≥35 years, < 0.001).
Exogenous FSH alone is probably sufficient for follicular development and hMG may not improve the embryo profile in a GnRH antagonist protocol across all age.
比较采用促性腺激素释放激素（GnRH）拮抗剂方案，联合卵泡刺激素（FSH）和人绝经期促性腺激素（hMG）进行体外受精/卵胞浆内单精子注射的胚胎结局。
我们对465例患者进行了一项回顾性队列研究。通过每日注射FSH开始刺激，在给予GnRH拮抗剂后，继续使用FSH（单纯FSH组）或给予hMG（FSH-hMG组）。主要结局为胚胎情况（取卵数、成熟卵数、受精卵数以及第3天形态良好的胚胎数）和内分泌情况。次要结局为促性腺激素的剂量和使用时间。数据按患者年龄分为两组：<35岁和≥35岁。
在<35岁的患者中，单纯FSH组的取卵数显著高于FSH-hMG组（13.7对9.2，P = 0.04），而在其他年龄组中无差异。在任何年龄，FSH-hMG组所需的促性腺激素量均显著更多（所有年龄，P < 0.001；<35岁，P = 0.013；≥35岁，P < 0.001）。
在GnRH拮抗剂方案中，单纯外源性FSH可能足以促进卵泡发育，hMG可能无法在所有年龄段改善胚胎情况。
