Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
FASEB J. 2021 Jul;35(7):e21696. doi: 10.1096/fj.202100406R.
During the in vitro fertilization treatment, human chorionic gonadotrophin (hCG) is routinely used as a substitute for the natural endogenous LH surge during the final stage of oocyte maturation. However, it does not provide the FSH surge observed in the mid-cycle of the natural cycle. To date, whether the FSH surge can improve oocyte quality and pregnancy outcomes remains unknown. Randomized controlled trials comparing the following four trigger methods to conventional hCG were examined: GnRH agonist (GnRHa), kisspeptin, GnRHa plus hCG (dual trigger), and FSH plus hCG (FSH co-trigger). The results showed that the use of dual triggers was associated with a significantly higher number of retrieved cumulus-oocyte complexes (COCs) (weighted mean difference [WMD] 1.625, 95% CI 0.684-2.565), retrieved mature oocytes (WMD 0.986, 95% CI 0.426-1.545) and fertilized (2PN) oocytes (WMD 0.792, 95% CI 0.083-1.501), compared with the use of hCG. However, there was no significant difference between the two groups in terms of pregnancy rate. The FSH co-trigger resulted in significantly higher rates of 2PN oocytes retrieved than the hCG trigger (WMD 0.077, 95% CI 0.028-0.126). Notably, the risk of OHSS did not differ among the three treatment groups compared to that of the hCG group. This review protocol was registered with PROSPERO (CRD 42020194201).
在体外受精治疗中，人绒毛膜促性腺激素（hCG）通常被用作替代卵母细胞成熟最后阶段天然内源性 LH 激增的药物。然而，它并不能提供自然周期中中周期观察到的 FSH 激增。迄今为止，FSH 激增是否能提高卵子质量和妊娠结局仍不清楚。本研究对以下四种与传统 hCG 相比的触发方法的随机对照试验进行了检查：促性腺激素释放激素激动剂（GnRHa）、 kisspeptin、GnRHa 加 hCG（双重触发）和 FSH 加 hCG（FSH 共触发）。结果表明，与使用 hCG 相比，使用双重触发方法与获卵数（加权均数差 [WMD] 1.625，95%置信区间 [CI] 0.684-2.565）、获成熟卵（WMD 0.986，95%CI 0.426-1.545）和受精（2PN）卵（WMD 0.792，95%CI 0.083-1.501）显著增加有关。然而，两组之间的妊娠率没有显著差异。FSH 共触发与 hCG 触发相比，获 2PN 卵的比例显著增加（WMD 0.077，95%CI 0.028-0.126）。值得注意的是，与 hCG 组相比，三组治疗组的 OHSS 风险没有差异。本综述方案已在 PROSPERO（CRD42020194201）上注册。
