Checa Miguel A, Brassesco Mario, Sastre Margalida, Gómez Manuel, Herrero Julio, Marque Laura, Brassesco Arturo, Espinós Juan José
Department of Obstetrics and Gynecology, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Infertilidad y Reproducción Humana (CIRH), Barcelona, Spain.
Centro de Infertilidad y Reproducción Humana (CIRH), Barcelona, Spain.
Int J Womens Health. 2015 Feb 12;7:219-25. doi: 10.2147/IJWH.S66743. eCollection 2015.
The aim of this study is to evaluate the feasibility and safety of random-start controlled ovarian hyperstimulation (COH) for emergency fertility preservation, regardless of the phase of the menstrual cycle. A self-controlled pilot clinical trial (NCT01385332) was performed in an acute-care teaching hospital and in two private reproductive centers in Barcelona, Spain. Eleven egg donors participated in the study. Two random-start gonadotropin-releasing hormone (GnRH) antagonist protocols were assessed in which ganirelix was initiated on either day 10 (protocol B) or on day 20 (protocol C) of the menstrual cycle and was continued until estradiol levels were below 60 pg/dL. These protocols were compared with a standard protocol (protocol A). The main outcome of interest was the number of metaphase 2 oocytes retrieved. Results from this study show that the number of mature oocytes retrieved was comparable across the different protocols (14.3±4.6 in the standard protocol versus 13.0±9.1 and 13.2±5.2 in protocols B and C, respectively; values expressed as mean ± standard deviation). The mean number of days needed for a GnRH antagonist to lower estradiol levels, as well as the ongoing pregnancy rates, were also similar when protocols B (stimulation in follicular phase) and C (stimulation on luteal phase) were compared with protocol A (standard stimulation). GnRH antagonists can be effectively used for random-start controlled ovarian hyperstimulation with an ovarian response similar to that of standard protocols, and the antagonists appear suitable for emergency fertility preservation in cancer patients.
本研究的目的是评估随机启动的控制性卵巢刺激（COH）用于紧急生育力保存的可行性和安全性，而不考虑月经周期的阶段。在西班牙巴塞罗那的一家急症教学医院和两家私立生殖中心进行了一项自身对照的试点临床试验（NCT01385332）。11名卵子捐赠者参与了该研究。评估了两种随机启动的促性腺激素释放激素（GnRH）拮抗剂方案，其中在月经周期的第10天（方案B）或第20天（方案C）开始使用加尼瑞克，并持续至雌二醇水平低于60 pg/dL。将这些方案与标准方案（方案A）进行比较。主要关注的结果是获得的中期II期卵母细胞数量。本研究结果表明，不同方案获得的成熟卵母细胞数量相当（标准方案中为14.3±4.6，方案B和方案C中分别为13.0±9.1和13.2±5.2；数值表示为均值±标准差）。当将方案B（卵泡期刺激）和方案C（黄体期刺激）与方案A（标准刺激）进行比较时，GnRH拮抗剂降低雌二醇水平所需的平均天数以及持续妊娠率也相似。GnRH拮抗剂可有效用于随机启动的控制性卵巢刺激，其卵巢反应与标准方案相似，且这些拮抗剂似乎适用于癌症患者的紧急生育力保存。
