GnRH拮抗剂在轻度卵巢过度刺激（MOH）的宫腔内人工授精（IUI）周期中的作用评估：一项前瞻性随机研究。
Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study.
作者信息
Wadhwa Leena, Khanna Rupali, Gupta Taru, Gupta Sangeeta, Arora Sarika, Nandwani Sumi
机构信息
Department of Obstetrics and Gynecology, ESI-Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, 110015 India ; Flat No 225, Sector-9, Pocket-1, DDA/SFS, Dwarka, New-Delhi, 110075 India.
Department of Obstetrics and Gynecology, ESI-Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, 110015 India.
出版信息
J Obstet Gynaecol India. 2016 Oct;66(Suppl 1):459-65. doi: 10.1007/s13224-015-0833-3. Epub 2016 Feb 26.
AIMS AND OBJECTIVE
To evaluate the role of GnRH antagonist in prevention of premature LH surge and increasing pregnancy rates in IUI cycle with mild ovarian hyperstimulation (MOH).
STUDY DESIGN
Prospective parallel, randomised controlled study.
MATERIAL AND METHODS
Couples diagnosed with unexplained, male factor subfertility and with one or both tubes patent were randomised to receive either a GnRH antagonist (study group) or no intervention (control group). All women were treated with clomiphene citrate (D3-D7) followed by HMG. A GnRH antagonist was added when one or more follicles of 16 mm diameter or more were visualised in the study group. When at least one follicle reached a size of ≥18 mm, ovulation was induced by hCG injection. A single IUI was performed 36 h later. The primary outcome was premature LH surge and pregnancy rate. The secondary outcomes were the amount of gonadotropins used, duration of use of GnRH antagonist and incidence and severity of OHSS.
RESULTS
A total of seventy patients attending the infertility clinic in the outpatient department of Obstetrics and Gynecology, of a tertiary care centre, were recruited in the study which was carried out from August 2011 to March 2013. The study group included 34 women and 36 in the control arm. The incidence of premature LH surge was significantly lower in the antagonist group as compared to the control group 2.9 vs. 13.9 %, with a p value of <0.001. The clinical pregnancy rates were similar in both the groups 8.8 vs. 11.1 %, p value being 1.000. The amount of gonadotropins used in GnRH antagonist group was lower than in control group but not statistically significant. Duration of GnRH antagonist was 1.85 ± 0.61 days in the study group.
CONCLUSION
The delayed administration of GnRH antagonists in MOH with IUI cycles when follicle size is ≥16 mm is beneficial in terms of preventing the occurrence of premature LH surge but with no improvement in pregnancy rates.
目的
评估促性腺激素释放激素（GnRH）拮抗剂在预防轻度卵巢过度刺激（MOH）的宫腔内人工授精（IUI）周期中过早出现促黄体生成素（LH）峰及提高妊娠率方面的作用。
研究设计
前瞻性平行随机对照研究。
材料与方法
诊断为不明原因、男性因素不育且一侧或双侧输卵管通畅的夫妇被随机分为两组，一组接受GnRH拮抗剂治疗（研究组），另一组不进行干预（对照组）。所有女性均接受枸橼酸氯米芬治疗（第3 - 7天），随后使用人绝经期促性腺激素（HMG）。当研究组中出现一个或多个直径≥16mm的卵泡时添加GnRH拮抗剂。当至少一个卵泡直径≥18mm时，注射人绒毛膜促性腺激素（hCG）诱导排卵。36小时后进行单次IUI。主要结局指标为过早LH峰和妊娠率。次要结局指标为促性腺激素用量、GnRH拮抗剂使用时长、卵巢过度刺激综合征（OHSS）的发生率及严重程度。
结果
2011年8月至2013年3月在一家三级医疗中心妇产科门诊不育诊所招募了70例患者进行本研究。研究组有34名女性，对照组有36名。与对照组相比，拮抗剂组过早LH峰的发生率显著更低，分别为2.9%和13.9%，p值<0.001。两组的临床妊娠率相似，分别为8.8%和11.1%，p值为1.000。GnRH拮抗剂组促性腺激素用量低于对照组，但差异无统计学意义。研究组GnRH拮抗剂使用时长为1.85±0.61天。
结论
在卵泡大小≥16mm的MOH合并IUI周期中延迟使用GnRH拮抗剂，在预防过早LH峰的发生方面有益，但妊娠率并无改善。
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