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优化多囊卵巢综合征患者体外受精的卵巢刺激：一种新型的第1天促性腺激素释放激素拮抗剂方案。

Optimizing Ovarian Stimulation for IVF in PCOS Patients: A Novel Day 1 GnRH Antagonist Protocol.

作者信息

Ghosh Dastidar Sudarsan, Ghosh Dastidar Biswanath, Chattopadhyay Ratna, Chakraborty Chandan

机构信息

GD Institute for Fertility Research, 36 A/1 S.P. Mukherjee Road, Kolkata 700025, West Bengal, India.

Department of Obstetrics and Gynecology & GDIFR-IPGMER Center of Excellence (COE) in Assisted Reproductive Technology (ART), Institute of Post-Graduate Medical Education and Research (IPGMER) & SSKM Hospital, 244 AJC Bose Road, Kolkata 700020, West Bengal, India.

出版信息

J Clin Med. 2025 Aug 21;14(16):5901. doi: 10.3390/jcm14165901.

DOI:10.3390/jcm14165901
PMID:40869727
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12387123/
Abstract

: Gonadotropin-releasing hormone (GnRH) antagonist protocols are preferred in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) as they provide the best combination of flexibility, acceptable outcomes, and safety. Numerous studies have compared outcomes between GnRH agonist long protocol and standard flexible antagonist protocol. However, there are scant studies investigating the effectiveness of antagonist administration from day 1 of ovarian stimulation in PCOS patients. : We performed a retrospective cohort study to compare laboratory and clinical outcomes in IVF between standard flexible day 5/day 6 versus day 1 GnRH antagonist protocol in PCOS patients. : Our data indicates significantly superior oocyte yield and top-quality embryo proportion in patients with antagonists from day 1. Cumulative clinical pregnancy rates also tended to be superior in this group. : Our findings indicate that administration of GnRH antagonists from day 1 of stimulation in PCOS patients undergoing IVF may lead to superior results.

摘要

促性腺激素释放激素（GnRH）拮抗剂方案在接受体外受精（IVF）的多囊卵巢综合征（PCOS）患者中更受青睐，因为它们在灵活性、可接受的结果和安全性方面提供了最佳组合。许多研究比较了GnRH激动剂长方案和标准灵活拮抗剂方案之间的结果。然而，很少有研究调查在PCOS患者中从卵巢刺激第1天开始使用拮抗剂的有效性。：我们进行了一项回顾性队列研究，以比较PCOS患者在标准灵活的第5天/第6天与第1天GnRH拮抗剂方案的IVF中的实验室和临床结果。：我们的数据表明，从第1天开始使用拮抗剂的患者的卵母细胞产量和优质胚胎比例明显更高。该组的累积临床妊娠率也往往更高。：我们的研究结果表明，在接受IVF的PCOS患者中，从刺激第1天开始使用GnRH拮抗剂可能会带来更好的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/a87e6719c163/jcm-14-05901-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/b06e14dc639a/jcm-14-05901-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/0fee3a3e7d58/jcm-14-05901-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/302527d87dfe/jcm-14-05901-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/a87e6719c163/jcm-14-05901-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/b06e14dc639a/jcm-14-05901-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/0fee3a3e7d58/jcm-14-05901-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/302527d87dfe/jcm-14-05901-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96b5/12387123/a87e6719c163/jcm-14-05901-g004.jpg

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本文引用的文献

1
Impact of GnRH antagonist pretreatment on oocyte yield after ovarian stimulation: A retrospective analysis.促性腺激素释放激素拮抗剂预处理对卵巢刺激后卵母细胞产量的影响：一项回顾性分析。
PLoS One. 2024 Oct 7;19(10):e0308666. doi: 10.1371/journal.pone.0308666. eCollection 2024.
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Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline.预防中重度卵巢过度刺激综合征：指南。
Fertil Steril. 2024 Feb;121(2):230-245. doi: 10.1016/j.fertnstert.2023.11.013. Epub 2023 Dec 13.
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Does Serum LH Level Influence IVF Outcomes in Women with PCOS Undergoing GnRH-Antagonist Stimulation: A Novel Indicator.
血清促黄体生成素水平对接受促性腺激素释放激素拮抗剂刺激的多囊卵巢综合征女性体外受精结局有影响吗：一项新指标
J Clin Med. 2022 Aug 11;11(16):4670. doi: 10.3390/jcm11164670.
4
Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis.多囊卵巢综合征患者体外受精/卵胞浆内单精子注射周期中，常规 GnRH 拮抗剂方案与长 GnRH 激动剂方案的比较：系统评价和荟萃分析。
Sci Rep. 2022 Mar 15;12(1):4456. doi: 10.1038/s41598-022-08400-z.
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Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper.多囊卵巢综合征排卵障碍妇女的生育力是否降低？专家观点。
Hum Reprod. 2021 Aug 18;36(9):2421-2428. doi: 10.1093/humrep/deab181.
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The Disorders of Endometrial Receptivity in PCOS and Its Mechanisms.多囊卵巢综合征中子宫内膜容受性障碍及其机制
Reprod Sci. 2022 Sep;29(9):2465-2476. doi: 10.1007/s43032-021-00629-9. Epub 2021 May 27.
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Early gonadotropin-releasing hormone antagonist protocol in women with polycystic ovary syndrome: A preliminary randomized trial.多囊卵巢综合征女性的早期促性腺激素释放激素拮抗剂方案：一项初步随机试验。
Clin Exp Reprod Med. 2018 Sep;45(3):135-142. doi: 10.5653/cerm.2018.45.3.135. Epub 2018 Sep 3.
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Polycystic Ovary Syndrome.多囊卵巢综合征。
Obstet Gynecol. 2018 Aug;132(2):321-336. doi: 10.1097/AOG.0000000000002698.
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Oocyte Competence in Women with Polycystic Ovary Syndrome.多囊卵巢综合征患者的卵母细胞成熟能力。
Trends Endocrinol Metab. 2017 Mar;28(3):186-198. doi: 10.1016/j.tem.2016.11.008. Epub 2016 Dec 14.
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The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance.多囊卵巢综合征患者排卵障碍性不孕的管理：支持制定全球世卫组织指南的证据分析。
Hum Reprod Update. 2016 Nov;22(6):687-708. doi: 10.1093/humupd/dmw025. Epub 2016 Aug 10.