Brzyski R G, Muasher S J, Droesch K, Simonetti S, Jones G S, Rosenwaks Z
Howard and Georgeanna Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk 23507.
Fertil Steril. 1988 Dec;50(6):917-21. doi: 10.1016/s0015-0282(16)60372-2.
The ability of gonadotropin-releasing hormone agonist (GnRHa) to cause an initial stimulation of serum gonadotropins was used for follicular recruitment for in vitro fertilization (IVF) in 12 patients with a history of low estradiol (E2) response to conventional gonadotropin stimulation. Stimulation was initiated on cycle day 3 with concurrent administration of leuprolide (1 mg/day subcutaneously) and follicle stimulating hormone (FSH, 4 ampules/day intramuscularly). An 8-fold increase in basal serum luteinizing hormone (LH) and a 4-fold increase in basal serum FSH was seen on cycle day 4. Serum progesterone levels rose significantly by day 6. When compared to prior IVF attempts in these patients, the mean day of human chorionic gonadotropin administration and corresponding E2 levels were not significantly different. More atretic oocytes and fewer preovulatory oocytes were retrieved using GnRHa, and no increase was seen in total oocytes retrieved. One patient was canceled for poor E2 response, and one patient conceived, with a current viable pregnancy. It is concluded that concurrent initiation of leuprolide and FSH stimulation on cycle day 3 in patients with prior low response does not improve oocyte recruitment, and the high LH environment generated from initial stimulation of the agonist may be detrimental to normal oocyte development.
对于12例既往对传统促性腺激素刺激雌二醇（E2）反应低下的患者，促性腺激素释放激素激动剂（GnRHa）引发血清促性腺激素初始刺激的能力被用于体外受精（IVF）的卵泡募集。在月经周期第3天开始刺激，同时皮下注射亮丙瑞林（1mg/天）和肌肉注射促卵泡激素（FSH，4支/天）。在月经周期第4天，基础血清黄体生成素（LH）增加了8倍，基础血清FSH增加了4倍。到第6天血清孕酮水平显著升高。与这些患者之前的IVF尝试相比，人绒毛膜促性腺激素给药的平均日期和相应的E2水平没有显著差异。使用GnRHa获取的闭锁卵泡更多，排卵前卵泡更少，获取的卵泡总数未见增加。1例患者因E2反应差而取消，1例患者怀孕，目前为活胎妊娠。结论是，对于既往反应低下的患者，在月经周期第3天同时开始亮丙瑞林和FSH刺激并不能改善卵泡募集，激动剂初始刺激产生的高LH环境可能对正常卵泡发育有害。
