Yokota Yoshimasa, Yokota Mikako, Yokota Hidemi, Makita Masami, Sato Setsuko, Araki Yasuhisa
Yokota Obstetrics/Gynecology Clinic, Maebashi and.
The Institute for ARMT, Ishii, Fujimi, Setagun, Gunma, Japan.
Reprod Med Biol. 2003 Sep 26;2(3):127-131. doi: 10.1046/j.1445-5781.2003.00033.x. eCollection 2003 Sep.
To assess the efficacy of estrogen rebound (ER) plus flare-up by gonadotropin releasing hormone agonist (GnRH-a) in poor responders who failed to become pregnant prior to a long protocol treatment. The patients comprised of thirty-one infertile patients with oocyte retrieval levels of less than five, who had undergone several long protocol treatment cycles. The efficacy of treatment with the ER plus flare-up from GnRH-a was compared with the prior long protocol treatment. The main outcome measures are: confirmation of ER, maximal serum E levels prior to human chorionic gonadotropin (hCG) administration, follicular development, dose, and duration of gonadotrophins in a clinical setting. The ER was confirmed by estrogen levels; FSH increased with ER plus flare-up from GnRH-a. Although the 31 patients included in the study had undergone frequent prior treatment cycles, including the long protocol, the pregnancy rate per embryo transfer following ER plus flare-up by GnRH-a was 37.5% (nine of 24). The number of follicles, number of oocytes retrieved, and the E level was higher than those found in prior treatment cycles. Exogenous estrogen administration with Premarin plus flare-up by GnRH-a may represent an alternative and effective protocol for poor responder patients who had previously undergone several prior long protocol treatments. (Reprod Med Biol 2003; : 127-131).
评估促性腺激素释放激素激动剂（GnRH-a）引发的雌激素反跳（ER）加 flare-up 在长方案治疗前未受孕的低反应者中的疗效。研究对象为 31 例取卵数少于 5 个的不孕患者，这些患者此前已接受过多个长方案治疗周期。将 ER 加 GnRH-a 引发的 flare-up 治疗效果与之前的长方案治疗进行比较。主要观察指标包括：ER 的确认、人绒毛膜促性腺激素（hCG）给药前的血清 E 峰值水平、卵泡发育情况、促性腺激素的剂量和疗程。通过雌激素水平确认 ER；ER 加 GnRH-a 引发的 flare-up 时 FSH 升高。尽管纳入研究的 31 例患者此前频繁接受包括长方案在内的治疗周期，但 GnRH-a 引发的 ER 加 flare-up 后每次胚胎移植的妊娠率为 37.5%（24 例中的 9 例）。卵泡数量、取卵数和 E 水平均高于之前的治疗周期。对于此前接受过多个长方案治疗的低反应患者，使用结合雌激素加 GnRH-a 引发的 flare-up 进行外源性雌激素给药可能是一种替代且有效的方案。（《生殖医学与生物学》2003 年；：127 - 131）
