Hossein Rashidi Batool, Tarafdari Azam, Ghazimirsaeed Seyedeh Tahereh, Shahrokh Tehraninezhad Ensieh, Keikha Fatemeh, Eslami Bita, Ghazimirsaeed Seyede Masomeh, Jafarabadi Mina
Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Shahid Aliabadi Clinical Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Family Reprod Health. 2020 Mar;14(1):14-20.
To compare the effect of dydrogesterone and Gonadotropin releasing hormone (GnRH) antagonists on prevention of premature luteinizing hormone (LH) surge and pregnancy outcomes in infertile women undergoing Invitro fertilization/ Intra cytoplasmic sperm injection (IVF/ICSI). In a Randomized controlled trial (RCT), two-hundred eligible women undergoing in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) treatment were randomly assigned into two groups. Human menopausal gonadotropin (HMG) was administered for controlled ovarian stimulation (COS) in both groups. Intervention group (group 1) received 20 mg dydrogesterone from day 2 of menstrual cycle till trigger day and control group (group2) received GnRH antagonist from the day that leading follicle reached 13 mm in diameter till trigger day. Serum levels of LH, estradiol and progesterone were measured on the trigger day. The primary outcome measure was the incidence of a premature LH surge, and the secondary outcomes investigated were the chemical and clinical pregnancy rates in the first FET cycles. There were no significant differences in patients' age, BMI, AMH levels, previous IVF cycle, and cause of infertility between the two groups. None of the patients in two groups experienced a premature luteinizing hormone surge. The numbers of retrieved oocytes, the MII oocytes and good quality embryos, were significantly higher in the intervention group than antagonist group (p < 0.05). The overall chemical pregnancy rate in intervention group (43/91: 46.2%) and control group (45/91: 49.5%) (p = 0.820) was similar. Meanwhile, the clinical pregnancy rate was similar between groups too. Regarding the cost, efficacy and easy usage of dydrogestrone, it may be reasonable to use it as an alternative to GnRH antagonist for the prevention of premature LH surge.
比较地屈孕酮与促性腺激素释放激素（GnRH）拮抗剂对接受体外受精/卵胞浆内单精子注射（IVF/ICSI）的不孕女性预防过早促黄体生成素（LH）峰及妊娠结局的影响。在一项随机对照试验（RCT）中，将200例接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗的符合条件的女性随机分为两组。两组均给予人绝经期促性腺激素（HMG）进行控制性卵巢刺激（COS）。干预组（第1组）从月经周期第2天至扳机日给予20mg地屈孕酮，对照组（第2组）从主导卵泡直径达到13mm之日起至扳机日给予GnRH拮抗剂。在扳机日测定血清LH、雌二醇和孕酮水平。主要结局指标是过早LH峰的发生率，次要结局指标是首次冻融胚胎移植（FET）周期中的生化妊娠率和临床妊娠率。两组患者的年龄、体重指数、抗苗勒管激素（AMH）水平、既往IVF周期及不孕原因均无显著差异。两组患者均未出现过早促黄体生成素峰。干预组的获卵数、成熟卵母细胞数和优质胚胎数均显著高于拮抗剂组（p<0.05）。干预组（43/91：46.2%）和对照组（45/91：49.5%）的总体生化妊娠率相似（p=0.820）。同时，两组的临床妊娠率也相似。考虑到地屈孕酮的成本、疗效和易用性，将其作为GnRH拮抗剂的替代品用于预防过早LH峰可能是合理的。
