Sopa Negjyp, Larsen Elisabeth Clare, Nyboe Andersen Anders
a The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.
Gynecol Endocrinol. 2018 Jul;34(7):623-626. doi: 10.1080/09513590.2018.1428302. Epub 2018 Jan 18.
Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5-14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R = 0.07, p < .01). The ongoing pregnancy rate per started cycle was 47.0%. Three (2.6%) developed OHSS, two had cancelation of the cycle and seven patients had GnRH agonist triggering to prevent OHSS. Selective use of a low dose of HP-hMG in patients with high levels of AMH provides 5-14 oocytes in more than two-thirds of the patients and is safe with low risk of OHSS. The number of aspirated oocytes was independent of AMH levels and ovulatory status, but inversely related to body weight.
抗缪勒管激素（AMH）水平高的女性发生卵巢过度刺激综合征（OHSS）的风险增加。研究表明，高度纯化的促性腺激素（HP-hMG）Menopur®可降低该风险。因此，我们研究了低剂量（112.5 IU/天）HP-hMG在排卵和无排卵的高AMH（>32 pmol/L）患者中的应用。主要终点是反应适当、过度和不足（5-14个、≥15个和≤4个卵母细胞）的患者分布情况。另一个终点是OHSS的发生率。总共纳入了115名女性，其中78名（67.8%）反应适当，8名（7.0%）过度，29名（25.2%）不足。卵母细胞数量与AMH水平和排卵状态无关，但随着体重增加而显著下降（R = 0.07，p < 0.01）。每个启动周期的持续妊娠率为47.0%。3名（2.6%）发生了OHSS，2名取消了周期，7名患者使用促性腺激素释放激素（GnRH）激动剂触发以预防OHSS。在高AMH水平的患者中选择性使用低剂量HP-hMG，超过三分之二的患者可获得5-14个卵母细胞，且安全，OHSS风险低。吸出的卵母细胞数量与AMH水平和排卵状态无关，但与体重呈负相关。
