The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark.
The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark.
Reprod Biomed Online. 2021 Jun;42(6):1108-1118. doi: 10.1016/j.rbmo.2021.03.011. Epub 2021 Mar 18.
Is the reproductive outcome similar after gonadotrophin-releasing hormone agonist (GnRHa) trigger followed by luteal human chorionic gonadotrophin (HCG) boluses compared with HCG trigger and a standard luteal phase support (LPS)?
Two open-label pilot randomized controlled trials (RCT) with 250 patients from 2014 to 2019, with a primary outcome of ongoing pregnancy per embryo transfer. Patients with ≤13 follicles on the trigger day were randomized (RCT 1) to: Group A (n = 65): GnRHa trigger followed by a bolus of 1500 IU HCG s.c. on the oocyte retrieval day (ORD) and 1000 IU HCG s.c. 4 days later, and no vaginal LPS; or Group B (n = 65): 6500 IU HCG trigger, followed by a standard vaginal progesterone LPS. Patients with 14-25 follicles on the trigger day were randomized (RCT 2) to Group C (n = 60): GnRHa trigger followed by 1000 IU HCG s.c. on ORD and 500 IU HCG s.c. 4 days later, and no vaginal LPS; or Group D (n = 60): 6500 IU HCG trigger and a standard vaginal LPS.
In RCT 1, the ongoing pregnancy rate was 44% (22/50) in the GnRHa group versus 46% (25/54) in the HCG trigger group (RR 0.95, 95% CI 0.62-1.45). No ovarian hyperstimulation syndrome (OHSS) was seen in Groups A or B. In RCT 2, the ongoing pregnancy rate was 51% (25/49) in the GnRHa group versus 60% (31/52) in the HCG trigger group (RR 0.86, 95% CI 0.60-1.22). The OHSS rates were 3.3% and 6.7%, respectively.
Although a larger-scale study is needed before standard clinical implementation, the present study supports that the exogenous progesterone-free LPS is efficacious, simple and patient-friendly.
与 hCG 扳机和标准黄体支持（LPS）相比，促性腺激素释放激素激动剂（GnRHa）扳机后给予黄体人绒毛膜促性腺激素（hCG）冲击与 hCG 扳机和标准黄体支持（LPS）相比，对生殖结局是否相似？
2014 年至 2019 年期间进行了两项开放标签的先导随机对照试验（RCT），共纳入 250 例患者，主要结局为胚胎移植后的持续妊娠率。扳机日≤13 个卵泡的患者随机分为（RCT1）：A 组（n=65）：GnRHa 扳机后，于取卵日（ORD）给予 1500 IU 皮下 hCG，4 天后给予 1000 IU 皮下 hCG，无阴道 LPS；或 B 组（n=65）：6500 IU hCG 扳机，然后进行标准阴道孕酮 LPS。扳机日 14-25 个卵泡的患者随机分为（RCT2）：C 组（n=60）：GnRHa 扳机后，于 ORD 给予 1000 IU 皮下 hCG，4 天后给予 500 IU 皮下 hCG，无阴道 LPS；或 D 组（n=60）：6500 IU hCG 扳机，然后进行标准阴道 LPS。
在 RCT1 中，GnRHa 组的持续妊娠率为 44%（22/50），hCG 扳机组为 46%（25/54）（RR 0.95，95%CI 0.62-1.45）。A 组和 B 组均未出现卵巢过度刺激综合征（OHSS）。在 RCT2 中，GnRHa 组的持续妊娠率为 51%（25/49），hCG 扳机组为 60%（31/52）（RR 0.86，95%CI 0.60-1.22）。OHSS 发生率分别为 3.3%和 6.7%。
尽管需要更大规模的研究才能在临床常规实施，但本研究支持外源性无孕激素 LPS 是有效、简单且对患者友好的。
