Verpoest Willem, De Vos Anick, De Rycke Martine, Parikh Shruti, Staessen Catherine, Tournaye Herman, De Vos Michel, Vloeberghs Veerle, Blockeel Christophe
Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
Curr Pharm Biotechnol. 2017 Nov 10;18(8):622-627. doi: 10.2174/1389201018666170808130526.
The use of GnRH analogue medication is essential in reproductive medicine to avoid premature ovulation by pituitary suppression for the duration of ovarian stimulation by gonadotrophins. The type of pituitary suppression by either GnRH agonist analogues versus GnRH antagonist analogues may result in different embryological hence clinical results. Preimplantation genetic diagnosis is a subtype of IVF in which embryos are created for genetic diagnosis of hereditary disorders in order to avoid genetically affected children. Embryological quality hence ovarian stimulation in preimplantation genetic diagnosis is crucial as genetic selection will reduce the number of available embryos to a fraction of the total.
The aim of this study was to assess the efficiency of GnRH antagonist versus GnRH agonist treatment for pituitary suppression in ovarian stimulation for PGD, by proxy of number and quality of embryos at cleavage stage available for biopsy.
We conducted a prospective randomised controlled trial comparing pituitary suppression by GnRH antagonist versus GnRH agonist in ovarian stimulation for PGD. The primary outcome measure was the number of embryos of sufficient quality for biopsy at cleavage stage. Secondary outcome parameters were the number of blastocysts available of top quality, and clinical pregnancy rate.
There was no difference in number of oocytes retrieved, embryos at cleavage stage available for biopsy or embryo quality. The clinical pregnancy rate was higher in the GnRH agonist group; however the sample size was insufficient to allow conclusions.
The use of GnRH agonist versus antagonist treatment does not result in differences in a number of oocytes, embryos or embryo quality in ovarian stimulation for preimplantation genetic diagnosis.
在生殖医学中，使用促性腺激素释放激素（GnRH）类似物药物对于在促性腺激素进行卵巢刺激期间通过抑制垂体来避免过早排卵至关重要。GnRH激动剂类似物与GnRH拮抗剂类似物对垂体的抑制类型可能导致不同的胚胎学结果，进而产生不同的临床结果。植入前基因诊断是体外受精（IVF）的一种亚型，在此过程中创建胚胎用于遗传性疾病的基因诊断，以避免生出受基因影响的儿童。因此，在植入前基因诊断中，胚胎质量以及卵巢刺激至关重要，因为基因筛选会将可用胚胎数量减少至总数的一小部分。
本研究的目的是通过可用于活检的卵裂期胚胎数量和质量，评估GnRH拮抗剂与GnRH激动剂治疗在植入前基因诊断的卵巢刺激中对垂体抑制的效果。
我们进行了一项前瞻性随机对照试验，比较GnRH拮抗剂与GnRH激动剂在植入前基因诊断的卵巢刺激中对垂体的抑制作用。主要结局指标是卵裂期有足够质量可用于活检的胚胎数量。次要结局参数是优质囊胚的数量和临床妊娠率。
回收的卵母细胞数量、可用于活检的卵裂期胚胎数量或胚胎质量没有差异。GnRH激动剂组的临床妊娠率较高；然而样本量不足，无法得出结论。
在植入前基因诊断的卵巢刺激中，使用GnRH激动剂与拮抗剂治疗在卵母细胞数量、胚胎数量或胚胎质量方面没有差异。
