Xing Weijie, Lin Haiyan, Li Yu, Yang Dongzi, Wang Wenjun, Zhang Qingxue
Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
PLoS One. 2015 Oct 15;10(10):e0140286. doi: 10.1371/journal.pone.0140286. eCollection 2015.
To determine if the GnRH antagonist protocol is effective in preventing ovarian hyperstimulation syndrome (OHSS) in potentially high responders.
A total of 660 IVF-ET/ICSI cycles were retrospectively identified. The inclusion criterion was age ≤ 30 years. Cycles were divided into two groups: a GnRHa group and a GnRHant group. In the GnRHa group, the patients received one single injection of 1.0mg-1.3mg Triptorelin in previous mid-luteal phase. In the GnRHant group, a daily dose of 0.25 mg Cetrotide was initiated when a lead follicle obtained a mean diameter of 14 mm, continued up until the day of hCG administration. The duration of stimulation, total dose of Gn, implantation rate, pregnancy rate, and OHSS rate were compared.
The duration of stimulation, E2 level on hCG day, numbers of oocytes retrieved, MII oocytes, and high-quality embryos in the GnRHa group were all significantly more than those in the GnRHant group. In the GnRHa group, 83.53% of cancelled fresh-transferred cycles were cancelled because of high risk of OHSS, which was significantly higher than that in the GnRHant group (43.55%, P<0.05). The incidence of OHSS in the GnRHa group was slightly higher than that in the GnRHant group. The implantation and clinical pregnancy rates in the GnRHa group were significantly higher than those in the GnRHant group (37.36% VS 19.25%, 62.78% VS 31.06%; P<0.05).
Our study demonstrated that for potentially high responders, the GnRHant protocol can, to some extent, lower the cancellation and incidence rates of OHSS. The GnRHa protocol was superior to the GnRHant protocol in terms of implantation and clinical pregnancy rates.
确定促性腺激素释放激素（GnRH）拮抗剂方案在预防潜在高反应者的卵巢过度刺激综合征（OHSS）方面是否有效。
回顾性纳入660个体外受精-胚胎移植/卵胞浆内单精子注射（IVF-ET/ICSI）周期。纳入标准为年龄≤30岁。将周期分为两组：GnRHa组和GnRH拮抗剂组。在GnRHa组中，患者在前一黄体中期单次注射1.0mg-1.3mg曲普瑞林。在GnRH拮抗剂组中，当主导卵泡平均直径达到14mm时开始每日注射0.25mg西曲瑞克，持续至注射人绒毛膜促性腺激素（hCG）当天。比较两组的刺激时间、促性腺激素（Gn）总剂量、种植率、妊娠率和OHSS发生率。
GnRHa组的刺激时间、hCG日的雌二醇（E2）水平、获卵数、成熟卵母细胞数和优质胚胎数均显著多于GnRH拮抗剂组。在GnRHa组中，83.53%的取消新鲜移植周期是因为OHSS高风险而取消，这显著高于GnRH拮抗剂组（43.55%，P<0.05）。GnRHa组的OHSS发生率略高于GnRH拮抗剂组。GnRHa组的种植率和临床妊娠率显著高于GnRH拮抗剂组（37.36%对19.25%，62.78%对31.06%；P<0.05）。
我们的研究表明，对于潜在高反应者，GnRH拮抗剂方案在一定程度上可以降低OHSS的取消率和发生率。GnRHa方案在种植率和临床妊娠率方面优于GnRH拮抗剂方案。
