Kitasaka Hiroya, Tokoro Mikiko, Kojima Masae, Fukunaga Noritaka, Asada Yoshimasa
Asada Ladies Clinic Nagoya Japan.
Asada Institute for Reproductive Medicine Kasugai Japan.
Reprod Med Biol. 2020 Dec 18;20(1):96-107. doi: 10.1002/rmb2.12359. eCollection 2021 Jan.
To assess the appropriateness of human chorionic gonadotropin (hCG) re-trigger in poor responders to gonadotropin-releasing hormone agonist (GnRHa) trigger in controlled ovarian stimulation (COS) cycles.
The 2251 cycles in 2251 patients triggered with GnRHa for oocyte stimulation, with or without requiring hCG re-trigger between 2013 and 2018, were retrospectively analyzed to compare gonadotropin levels at the start of COS and the rate of normal fertilization between the re-trigger and non-re-trigger group. Furthermore, patients in the re-trigger group were stratified by the rate of normal fertilization (good: ≥60% or poor: <60%) to compare patient demographics, hormone profiles, and clinical outcome between the subgroups.
In the re-trigger group, FSH and LH levels at the start of COS were significantly lower in the good fertilization group than in the poor fertilization group ( < .01). Receiver operating characteristic curves identified cutoff values of the FSH and LH levels of 1.30 and 0.35 mIU/mL, respectively, for predicting ≥60% normal fertilization.
Gonadotropin levels at the start of COS are predictors of response to GnRHa trigger and hCG re-trigger necessity, and may serve as indicators to help clinicians appropriately choose hCG re-trigger rather than abandoning the cycles or continuing the first oocyte aspiration attempt.
评估在控制性卵巢刺激（COS）周期中，对促性腺激素释放激素激动剂（GnRHa）触发反应不良的患者使用人绒毛膜促性腺激素（hCG）再次触发的适宜性。
回顾性分析2013年至2018年间2251例接受GnRHa触发进行卵母细胞刺激的患者的2251个周期，这些患者无论是否需要hCG再次触发，比较COS开始时的促性腺激素水平以及再次触发组和未再次触发组之间的正常受精率。此外，将再次触发组的患者按正常受精率分层（良好：≥60%或不良：<60%），以比较亚组之间的患者人口统计学、激素谱和临床结局。
在再次触发组中，良好受精组COS开始时的FSH和LH水平显著低于不良受精组（<0.01）。受试者工作特征曲线确定FSH和LH水平的截断值分别为1.30和0.35 mIU/mL，用于预测≥60%的正常受精。
COS开始时的促性腺激素水平是对GnRHa触发反应和hCG再次触发必要性的预测指标，可作为帮助临床医生适当选择hCG再次触发而非放弃周期或继续首次卵母细胞抽吸尝试的指标。
