Beck-Fruchter Ronit, Baram Shira, Geslevich Yoel, Weiss Amir
Department of Obstetrics and Gynecology, Fertility and In-Vitro Fertilization Unit, Emek Medical Center, Afula,
Department of Obstetrics and Gynecology, Fertility and In-Vitro Fertilization Unit, Emek Medical Center, Afula, Israel.
Gynecol Obstet Invest. 2019;84(1):27-34. doi: 10.1159/000490946. Epub 2018 Jul 26.
BACKGROUND/AIMS: Gonadotropin releasing hormone (GnRH) agonist triggering results in an endogenous gonadotropin flare. Although it effectively stimulates ovulation, GnRH agonist triggers results in an early luteolysis and requires modification of the luteal support. The current study aims to evaluate GnRH agonist triggering with exclusive human chorionic gonadotropin (hCG) luteal support.
In this prospective observational study, 56 normogonadotropic-assisted reproductive technology patients, stimulated using a GnRH-antagonist protocol, were studied. Final oocyte maturation was achieved with 0.2 mg triptorelin acetate followed by progesterone free luteal support with human choriogonadotropin (1,500 IU * 2). A control group was selected from a pool of 1,023 normogonadotropic patients who received Choriogonadotropin alfa for final oocyte maturation and progesterone suppositories for luteal support.
No significant difference was found for the number of oocytes, oocyte maturation rate, fertilization and implantation rate, clinical pregnancy rate (25 vs. 26.7%) and live birth rate (25 vs. 21.4%). Progesterone levels in conception cycles were significantly higher in the study group than corresponding levels in the control group.
GnRH agonist triggering with exclusive hCG support may be a valid alternative to hCG triggering with progesterone support. This protocol combines the potential advantages of a physiological trigger with a simple, patient-friendly, luteal support.
背景/目的：促性腺激素释放激素（GnRH）激动剂触发会导致内源性促性腺激素激增。尽管它能有效刺激排卵，但GnRH激动剂触发会导致早期黄体溶解，需要调整黄体支持方案。本研究旨在评估单纯使用人绒毛膜促性腺激素（hCG）进行黄体支持的GnRH激动剂触发方案。
在这项前瞻性观察研究中，对56名使用GnRH拮抗剂方案进行刺激的正常促性腺激素水平的辅助生殖技术患者进行了研究。使用0.2mg醋酸曲普瑞林实现最终卵母细胞成熟，随后使用人绒毛膜促性腺激素（1500IU×2）进行无孕酮黄体支持。对照组从1023名正常促性腺激素水平的患者中选取，这些患者使用重组人促卵泡激素α实现最终卵母细胞成熟，并使用黄体酮栓剂进行黄体支持。
两组在卵母细胞数量、卵母细胞成熟率、受精率、着床率、临床妊娠率（25%对26.7%）和活产率（25%对21.4%）方面均无显著差异。研究组妊娠周期中的孕酮水平显著高于对照组的相应水平。
单纯使用hCG支持的GnRH激动剂触发方案可能是使用黄体酮支持的hCG触发方案的有效替代方案。该方案结合了生理性触发的潜在优势以及简单、对患者友好的黄体支持。
