Division of Gynaecologic Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Mount Sinai Fertility, 7th floor, 250 Dundas Street West, Toronto, Ontario, M5T 2Z5, Canada.
Reprod Biol Endocrinol. 2020 Jun 5;18(1):59. doi: 10.1186/s12958-020-00614-y.
Random-start, controlled ovarian stimulation (COS) has advanced the field of fertility preservation, allowing patients to expedite fertility treatment and avoid further delays to their cancer therapy. This novel approach allows patients to initiate ovarian stimulation at any point, regardless of where they are in their menstrual cycle. Luteal-phase start (LPS) protocols describe treatment cycles where COS is initiated during the luteal-phase of the menstrual cycle. LPS protocols have not been studied or optimized to the same degree as conventional, early-follicular COS. Particularly, there is a paucity of evidence evaluating treatment outcomes using different trigger medications in LPS protocols. The present study aims to evaluate the efficacy of using a GnRH agonist (GnRH-a) trigger in patients undergoing oocyte cryopreservation in LPS protocols.
This descriptive case series describes two patients, recently diagnosed with cancer, who underwent oocyte cryopreservation using an LPS protocol and a GnRH-a trigger at a university-affiliated, academic center.
The patients described in our case series both failed to adequately respond to a GnRH-a trigger, based on their serum levels of luteinizing hormone (LH) and progesterone 12 h after their GnRH-a trigger. They both required a single rescue dose of human chorionic gonadotropin (hCG).
These findings highlight the potential risk of a suboptimal response to a GnRH-a trigger in patients undergoing LPS, controlled ovarian stimulation for oocyte cryopreservation. This risk might be attributed to the downregulation of GnRH receptors by elevated serum progesterone levels during the luteal phase. Currently, there is insufficient evidence to recommend for or against the use of a GnRH-a trigger during LPS controlled ovarian stimulation. This case series offers a number of management strategies to mitigate this risk and emphasizes the need for further research in this area.
随机起始的控制性卵巢刺激（COS）推动了生育力保存领域的发展，使患者能够加速生育力治疗并避免癌症治疗的进一步延误。这种新方法允许患者在任何时间开始卵巢刺激，而无需考虑他们的月经周期处于哪个阶段。黄体期起始（LPS）方案描述了在月经周期黄体期开始进行 COS 的治疗周期。与传统的早卵泡期 COS 相比，LPS 方案尚未得到同等程度的研究和优化。特别是，缺乏使用 LPS 方案中不同触发药物评估治疗结果的证据。本研究旨在评估在 LPS 方案中使用 GnRH 激动剂（GnRH-a）触发剂对接受卵母细胞冷冻保存的患者的疗效。
这是一项描述性病例系列研究，描述了在一所大学附属医院接受 LPS 方案和 GnRH-a 触发剂进行卵母细胞冷冻保存的两名最近诊断患有癌症的患者。
我们病例系列中的两名患者，根据 GnRH-a 触发后 12 小时血清黄体生成素（LH）和孕酮水平，均未能对 GnRH-a 触发剂充分反应。他们都需要单次人绒毛膜促性腺激素（hCG）补救剂量。
这些发现强调了在 LPS 方案中进行卵母细胞冷冻保存的患者对 GnRH-a 触发剂反应不佳的潜在风险。这种风险可能归因于黄体期血清孕酮水平升高导致 GnRH 受体下调。目前，尚无足够的证据推荐或反对在 LPS 控制卵巢刺激中使用 GnRH-a 触发剂。本病例系列提供了一些管理策略来降低这种风险，并强调了在该领域进一步研究的必要性。
