Meyer Laura, Murphy Lauren A, Gumer Arielle, Reichman David E, Rosenwaks Zev, Cholst Ina N
Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.
School of Medicine, George Washington University, Washington, D.C.
Fertil Steril. 2015 Sep;104(3):637-42. doi: 10.1016/j.fertnstert.2015.06.011. Epub 2015 Jul 3.
To identify risk factors for a suboptimal response to gonadotropin-releasing hormone (GnRH) agonist trigger in in vitro fertilization (IVF) cycles.
Retrospective cohort study.
Academic medical center.
PATIENT(S): All 424 patients undergoing fresh IVF cycles (n = 500) between August 2007 and June 2013 in whom a GnRH agonist was used as all or part of the ovulation trigger.
INTERVENTION(S): GnRH-antagonist-based IVF cycles triggered with leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin.
MAIN OUTCOME MEASURE(S): Suboptimal response to GnRH-agonist trigger, as defined by a serum luteinizing hormone (LH) level <15 mIU/mL on the morning after trigger.
RESULT(S): The rate of suboptimal response to the GnRH-agonist trigger was 5.2%. Patients with a suboptimal hormone response had lower follicle-stimulating hormone (<0.1 vs. 3.48) and LH (<0.1 vs. 2.51) levels on day 2 of the cycle start, lower LH (0.109 vs. 0.596) on the day of trigger, and required longer stimulation and more gonadotropins than those with an adequate response. Suboptimal responders were also more likely to have irregular menses and be on long-term oral contraception. Patients with an undetectable LH on the day of trigger had a 25% chance of a suboptimal LH surge. In our study cohort, limiting the use of the GnRH-agonist trigger alone to patients with a trigger day LH ≥0.5 would have reduced the rate of suboptimal response from 5.2% to 0.2%.
CONCLUSION(S): Long-term hormonal contraception use is an independent risk factor for suboptimal response to GnRH-agonist trigger. Patients with very low endogenous serum LH levels on the day of LH trigger are at increased risk for a suboptimal GnRH-agonist trigger response. Understanding the at-risk phenotype and using trigger day LH as a marker for increased risk of suboptimal GnRH-agonist trigger response can be helpful for individualizing treatment and selecting a safe and efficacious trigger medication for patients undergoing IVF.
确定体外受精（IVF）周期中促性腺激素释放激素（GnRH）激动剂扳机效果欠佳的危险因素。
回顾性队列研究。
学术医疗中心。
2007年8月至2013年6月期间接受新鲜IVF周期治疗（n = 500）的所有424例患者，其中使用GnRH激动剂作为全部或部分排卵扳机。
基于GnRH拮抗剂的IVF周期，单独使用醋酸亮丙瑞林或与低剂量人绒毛膜促性腺激素联合使用作为扳机。
GnRH激动剂扳机效果欠佳，定义为扳机后次日早晨血清促黄体生成素（LH）水平<15 mIU/mL。
GnRH激动剂扳机效果欠佳的发生率为5.2%。激素反应欠佳的患者在周期开始第2天的促卵泡生成素水平较低（<0.1对3.48）和LH水平较低（<0.1对2.51），扳机当天的LH水平较低（0.109对0.596），与反应良好的患者相比，需要更长的刺激时间和更多的促性腺激素。扳机效果欠佳的患者也更有可能月经不规律且正在使用长效口服避孕药。扳机当天LH检测不到的患者有25%的几率出现欠佳的LH峰。在我们的研究队列中，将单独使用GnRH激动剂扳机限制于扳机当天LH≥0.5的患者，会使欠佳反应的发生率从5.2%降至0.2%。
长期使用激素避孕是GnRH激动剂扳机效果欠佳的独立危险因素。LH扳机当天内源性血清LH水平极低的患者，GnRH激动剂扳机反应欠佳的风险增加。了解高危表型并将扳机当天的LH作为GnRH激动剂扳机反应欠佳风险增加的标志物，有助于为接受IVF的患者进行个体化治疗并选择安全有效的扳机药物。
