Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
J Formos Med Assoc. 2020 Nov;119(11):1642-1649. doi: 10.1016/j.jfma.2019.12.006. Epub 2020 Jan 20.
BACKGROUND/PURPOSE: To investigate whether switching GnRH antagonist (GnRHant) to medroxyprogesterone acetate (MPA) sequentially in the middle of controlled ovarian stimulation could effectively prevent premature LH surge in a GnRHant protocol in patients turn out to be at a high risk of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation.
This is a retrospective cohort study.
Premature LH surge did not occur in both groups of patients. The switch protocol group had a significantly fewer days of GnRHant treatment (3.1 ± 1.0 vs. 6.5 ± 1.2) compared with GnRHant protocol group. The mean duration of MPA treatment was 3.6 ± 1.1 days. There were no statistically significant differences in terms of live birth, implantation, and clinical pregnancy rates.
This study showed that MPA could sequentially replace GnRHant and effectively prevent premature LH surge after several days of GnRHant administration in patients being at high risk of OHSS during controlled ovarian stimulation. Switch protocol could individualize freeze-all policy and reduce the injection burden of GnRHant.
背景/目的：研究在控制性卵巢刺激过程中，在 GnRH 拮抗剂（GnRHant）治疗中期序贯转换醋酸甲羟孕酮（MPA），是否能有效预防 GnRHant 方案中卵巢过度刺激综合征（OHSS）高危患者的过早 LH 峰。
这是一项回顾性队列研究。
两组患者均未发生过早 LH 峰。与 GnRHant 方案组相比，转换方案组 GnRHant 治疗天数明显减少（3.1 ± 1.0 天 vs. 6.5 ± 1.2 天）。MPA 治疗的平均持续时间为 3.6 ± 1.1 天。活产率、种植率和临床妊娠率均无统计学差异。
本研究表明，在控制性卵巢刺激过程中，对于 OHSS 高危患者，在 GnRHant 治疗数天后序贯转换 MPA 可有效预防过早 LH 峰。转换方案可使冷冻保存策略个体化，并减少 GnRHant 的注射负担。
