Shen Xiuzhen, Yang Qinjie, Li Lanfang, Lu Wenhao
Reproductive Center, Taizhou Hospital of Zhejiang Province, Taizhou, China.
Ultrasound Department, Taizhou Hospital of Zhejiang Province, Taizhou, China.
Evid Based Complement Alternat Med. 2021 Oct 25;2021:2180933. doi: 10.1155/2021/2180933. eCollection 2021.
Ovarian hyperstimulation syndrome (OHSS) is a side effect of the exogenous human chorionic gonadotropin (hCG) hormones used to trigger oocyte maturation. High ovarian responders represent a population with a higher risk of OHSS and are characterized by an exaggerated response to gonadotropin administration. In this study, we compared clinical pregnancy and incidence of OHSS in high ovarian responders receiving different doses of hCG supplementation in a GnRH-agonist trigger protocol.
A total of 205 high ovarian responders who were to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were recruited and randomly assigned to receive different doses of hCG supplementation in a GnRH-agonist trigger protocol: GnRH-a ( = 42), GnRH-a + 1000 IU hCG ( = 49), GnRH-a + 2000 IU hCG ( = 54), and GnRH-a + 3000 IU hCG ( = 60) groups.
The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a group ( < 0.05). The GnRH-a + 1000 IU hCG group demonstrated more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( < 0.05). No moderate and severe OHSS cases occurred in the GnRH-a and GnRH-a + 1000 IU hCG groups. The incidence rate of moderate and severe OHSS was remarkably lower in the GnRH-a group and GnRH-a + 1000 IU hCG groups than in the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( < 0.05). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a higher clinical pregnancy rate than the GnRH-a group, showing no significant difference ( > 0.05). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a lower abortion rate than the GnRH-a group ( < 0.05).
Based on the data obtained from this prospective study, we recommend 1000 IU hCG supplementation in a GnRH-agonist trigger protocol for high ovarian responders during IVF/ICSI cycles considering a higher rate of high-quality embryos, a lower incidence rate of moderate and severe OHSS, and a lower abortion rate.
卵巢过度刺激综合征（OHSS）是用于触发卵母细胞成熟的外源性人绒毛膜促性腺激素（hCG）的一种副作用。高卵巢反应者是发生OHSS风险较高的人群，其特征是对促性腺激素给药反应过度。在本研究中，我们比较了在促性腺激素释放激素（GnRH）激动剂触发方案中接受不同剂量hCG补充的高卵巢反应者的临床妊娠情况和OHSS发生率。
共招募了205例即将接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）周期的高卵巢反应者，并随机分配至在GnRH激动剂触发方案中接受不同剂量hCG补充的组：GnRH-a组（n = 42）、GnRH-a + 1000 IU hCG组（n = 49）、GnRH-a + 2000 IU hCG组（n = 54）和GnRH-a + 3000 IU hCG组（n = 60）。
GnRH-a + 1000 IU hCG组、GnRH-a + 2000 IU hCG组和GnRH-a + 3000 IU hCG组回收的卵母细胞、胚胎、优质胚胎数量均多于GnRH-a组，优质胚胎率也高于GnRH-a组（P < 0.05）。GnRH-a + 1000 IU hCG组回收的卵母细胞、胚胎、优质胚胎数量多于GnRH-a + 2000 IU hCG组和GnRH-a + 3000 IU hCG组，优质胚胎率也高于这两组（P < 0.05）。GnRH-a组和GnRH-a + 1000 IU hCG组未发生中度和重度OHSS病例。GnRH-a组和GnRH-a + 1000 IU hCG组中度和重度OHSS的发生率明显低于GnRH-a + 2000 IU hCG组和GnRH-a + 3000 IU hCG组（P < 0.05）。GnRH-a + 1000 IU hCG组、GnRH-a + 2000 IU hCG组和GnRH-a + 3000 IU hCG组的临床妊娠率高于GnRH-a组，但差异无统计学意义（P > 0.05）。GnRH-a + 1000 IU hCG组、GnRH-a + 2000 IU hCG组和GnRH-a + 3000 IU hCG组的流产率低于GnRH-a组（P < 0.05）。
基于本前瞻性研究获得的数据，考虑到优质胚胎率较高、中度和重度OHSS发生率较低以及流产率较低，我们建议在IVF/ICSI周期中，对于高卵巢反应者，在GnRH激动剂触发方案中补充1000 IU hCG。
