Reproductive Medicine Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Endocrinol (Lausanne). 2020 May 29;11:318. doi: 10.3389/fendo.2020.00318. eCollection 2020.
Although pre-treatment with a GnRH agonist can reduce the size of adenomyosis lesions, the supra-physiological hormone level induced by controlled ovarian hyperstimulation (COH) may negate the usefulness of the GnRH agonist in patients with adenomyosis lesions, leading to continued poor outcomes in fresh embryo transfer cycles during fertilization (IVF). It is unclear whether GnRH agonist pre-treatment before starting the long GnRH agonist protocol for IVF/ICSI (intracytoplasmic sperm injection) can improve cumulative live birth rate (CLBR) of infertile women with adenomyosis. In this retrospective cohort study, a total of 374 patients diagnosed as adenomyosis (477 cycles) underwent IVF/ICSI with long GnRH agonist protocol with or without GnRH agonist pre-treatment between January 2009 and June 2018. Logistic regression was used to assess the association between GnRH agonist pre-treatment and pregnancy outcome after adjusting for confounding factors. The live birth rate in fresh embryo transfer cycles was higher in the non-pre-treatment group than in the GnRH agonist pre-treatment group (37.7 vs. 21.2%, = 0.028); the adjusted odds ratio (OR) for the long agonist protocol without pre-treatment was 1.966 (95% CI: 0.9-4.296, = 0.09). The CLBR was higher in the non-pre-treatment group than in the GnRH agonist pre-treatment group (40.50 vs. 27.90%, = 0.019); the adjusted OR for the long agonist protocol without pre-treatment was 1.361 (95% CI: 0.802-2.309, = 0.254). Our results indicated that GnRH agonist pre-treatment before starting the long GnRH agonist protocol does not improve the live birth rate in fresh embryo transfer cycles or CLBR in infertile women with adenomyosis after IVF/ICSI treatment when compared to that in non-pre-treated patients. A subsequent prospective randomized controlled study is needed to confirm these results.
尽管 GnRH 激动剂预处理可以缩小子宫腺肌病病灶的大小，但控制性卵巢过度刺激（COH）引起的超生理激素水平可能使 GnRH 激动剂在有子宫腺肌病病灶的患者中失去作用，导致在新鲜胚胎移植周期中受精（IVF）的结局仍然不佳。目前尚不清楚在开始 IVF/ICSI（胞浆内精子注射）的长效 GnRH 激动剂方案之前，进行 GnRH 激动剂预处理是否可以提高患有子宫腺肌病的不孕妇女的累积活产率（CLBR）。在这项回顾性队列研究中，共有 374 名被诊断为子宫腺肌病的患者（477 个周期）于 2009 年 1 月至 2018 年 6 月期间接受了 IVF/ICSI 联合长效 GnRH 激动剂方案，其中部分患者在开始该方案前接受了 GnRH 激动剂预处理。采用 logistic 回归分析在调整混杂因素后评估 GnRH 激动剂预处理与妊娠结局之间的关联。新鲜胚胎移植周期的活产率在未预处理组高于 GnRH 激动剂预处理组（37.7%比 21.2%，=0.028）；未预处理的长效激动剂方案的调整后比值比（OR）为 1.966（95%CI：0.9-4.296，=0.09）。CLBR 在未预处理组高于 GnRH 激动剂预处理组（40.50%比 27.90%，=0.019）；未预处理的长效激动剂方案的调整后 OR 为 1.361（95%CI：0.802-2.309，=0.254）。我们的结果表明，与未预处理的患者相比，在开始长效 GnRH 激动剂方案之前进行 GnRH 激动剂预处理并不能提高接受 IVF/ICSI 治疗的子宫腺肌病不孕妇女的新鲜胚胎移植周期的活产率或 CLBR。需要进行后续的前瞻性随机对照研究来证实这些结果。
