Krishna Deepika, Dhoble Snehal, Praneesh Gautham, Rathore Suvarna, Upadhaya Amit, Rao Kamini
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
J Hum Reprod Sci. 2016 Jul-Sep;9(3):164-172. doi: 10.4103/0974-1208.192056.
The objective of this study is to evaluate if gonadotropin-releasing hormone agonist (GnRHa) trigger is a better alternative to human chorionic gonadotropin (hCG) in polycystic ovary syndrome (PCOS) of Indian origin undergoing fertilization (IVF) cycles with GnRH antagonist for the prevention of ovarian hyperstimulation syndrome (OHSS).
Prospective randomized control trial.
Tertiary care center.
A total of 227 patients diagnosed with PCOS, undergoing IVF in an antagonist protocol were recruited and randomly assigned into two groups: Group A (study group): GnRHa trigger 0.2 mg ( = 92) and Group B (control group): 250 μg of recombinant hCG as trigger ( = 101) 35 h before oocyte retrieval. We chose segmentation strategy, freezing all embryos in both the groups.
Continuous variables were expressed as mean ± standard deviation independent sample -test and Kolmogorov-Smirnov test were used for continuous variables which were normally distributed and Mann-Whitney U-test for data not normally distributed.
Primary outcome: OHSS (mild, moderate, and severe) rates. Secondary outcomes: Maturity rate of the oocytes, fertilization rate, availability of top quality embryos on day 3 (Grade 1 and Grade 2).
The incidence of moderate to severe OHSS in the hCG group was 37.6% and 0% in the GnRHa group with < 0.001. The GnRHa group had significantly more mature oocytes retrieved (19.1 ± 11.7 vs. 14.1 ± 4.3), more fertilized oocytes (15.6 ± 5.6 vs. 11.7 ± 3.6), and a higher number of top quality cleavage embryos on day 3 (12.9 ± 4.7 vs. 7.5 ± 4.3) than the hCG group.
The most effective strategy which significantly eliminates the occurrence of OHSS in PCOS following ovarian stimulation in antagonist IVF cycles is the use of GnRHa trigger yielding more mature oocytes and good quality embryos when compared with hCG trigger.
本研究的目的是评估在接受体外受精（IVF）周期且使用促性腺激素释放激素拮抗剂的印度裔多囊卵巢综合征（PCOS）患者中，促性腺激素释放激素激动剂（GnRHa）触发剂是否是比人绒毛膜促性腺激素（hCG）更好的预防卵巢过度刺激综合征（OHSS）的替代方案。
前瞻性随机对照试验。
三级医疗中心。
共招募227例诊断为PCOS且采用拮抗剂方案进行IVF的患者，并随机分为两组：A组（研究组）：在取卵前35小时使用0.2mg GnRHa触发剂（n = 92）；B组（对照组）：使用250μg重组hCG作为触发剂（n = 101）。我们采用分段策略，将两组的所有胚胎进行冷冻。
连续变量以均数±标准差表示，对正态分布的连续变量采用独立样本t检验和Kolmogorov - Smirnov检验，对非正态分布的数据采用Mann - Whitney U检验。
主要结局：OHSS（轻度、中度和重度）发生率。次要结局：卵母细胞成熟率、受精率、第3天优质胚胎（1级和2级）的可得率。
hCG组中重度OHSS的发生率为37.6%，GnRHa组为0%，P < 0.001。GnRHa组回收的成熟卵母细胞显著更多（19.1±11.7对14.1±4.3），受精的卵母细胞更多（15.6±5.6对11.7±3.6），且第3天优质分裂期胚胎数量更高（12.9±4.7对7.5±4.3）。
在拮抗剂IVF周期中，能显著消除PCOS患者卵巢刺激后OHSS发生的最有效策略是使用GnRHa触发剂，与hCG触发剂相比，其能产生更多成熟卵母细胞和优质胚胎。
