Fusi Francesco M, Arnoldi Mariangela, Bosisio Chiara, Lombardo Grazia, Ferrario Marina, Zanga Laura, Galimberti Alessia, Capitanio Enrica
a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and.
b School of Obstetrics, University of Milano-Bicocca , Milano , Italy.
Gynecol Endocrinol. 2015;31(9):693-7. doi: 10.3109/09513590.2015.1025379. Epub 2015 Aug 31.
The aim of this study was to compare GnRHa trigger and luteal addition of triptorelin to hCG trigger for final oocyte maturation in women at high risk for OHSS undergoing IVF. A total of 423 patients were divided in two groups both stimulated using antagonist short protocol. Gonadotropins 75-150 UI/day were started on day 2-5, GnRH antagonist was added when the lead follicle was >14 mm and the final trigger was obtained with hCG 250 µg or triptorelin 0.2 mg. The luteal phase was supported with progesterone alone in the hCG group, with progesterone plus triptorelin 0.1 every other day from embryo transfer in the triptorelin group. In the triptorelin group we did neither have to suspend any embryo transfer, nor we have any early clinical OHSS. In the control group, 13 patients were suspended due to symptomatic high risk for OHSS and two patients developed a clinically significant OHSS. No statistically significant difference was observed in terms of clinical and ongoing pregnancy rates and implantation rates. Our results indicate that a protocol including GnRHa as trigger and an intensive luteal phase supported with GnRHa is safer than a standard antagonist protocol using hCG as trigger. It displays similar results, therefore it can be used as the first choice in patients at high risk for OHSS.
本研究的目的是比较促性腺激素释放激素激动剂（GnRHa）触发与在黄体期添加曲普瑞林至人绒毛膜促性腺激素（hCG）触发方案，用于体外受精（IVF）中卵巢过度刺激综合征（OHSS）高风险女性的最终卵母细胞成熟。总共423例患者被分为两组，均采用拮抗剂短方案进行刺激。促性腺激素从第2 - 5天开始使用，剂量为75 - 150 UI/天，当主导卵泡>14 mm时添加GnRH拮抗剂，最终触发采用250 μg hCG或0.2 mg曲普瑞林。hCG组在黄体期仅用黄体酮支持，曲普瑞林组从胚胎移植开始每隔一天用黄体酮加0.1 mg曲普瑞林支持。在曲普瑞林组，我们既无需暂停任何胚胎移植，也没有出现任何早期临床OHSS。在对照组中，13例患者因OHSS高风险症状而暂停，2例患者发生了具有临床意义的OHSS。在临床妊娠率、持续妊娠率和着床率方面未观察到统计学上的显著差异。我们的结果表明，一种包括GnRHa作为触发剂并在黄体期用GnRHa强化支持的方案比使用hCG作为触发剂的标准拮抗剂方案更安全。它显示出相似的结果，因此可作为OHSS高风险患者的首选方案。
