Gelety T J, Pearlstone A C, Surrey E S
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, University of California at Los Angeles School of Medicine, USA.
Fertil Steril. 1995 Dec;64(6):1074-80. doi: 10.1016/s0015-0282(16)57963-1.
To determine short-term pituitary and ovarian hormonal responses to GnRH agonist (GnRH-a) administered during various phases of the menstrual cycle, in the absence of controlled ovarian hyperstimulation (COH), to determine its independent effect on hormonal parameters previously demonstrated to influence assisted reproductive technology cycle outcome.
Prospective, randomized, controlled crossover study of five regularly cycling women. The GnRH-a, leuprolide acetate (LA), was administered 1 mg SC daily for 5 days beginning on cycle day 3 (early follicular); 8 days post-LH surge (midluteal); or 13 days post-LH surge (late-luteal).
Clinical research unit at a tertiary care medical center.
Serum gonadotropins (LH and FSH) and gonadal steroids (E2, estrone [E1], P, A, and T) measured daily during GnRH-a administration begun in the early follicular, midluteal, or late luteal phase of the menstrual cycle. Gonadotropin pulse amplitude and frequency were determined after frequent serum sampling on the 2nd day of GnRH-a administration in each treatment cycle.
Serum LH elevations, 4- to 10-fold greater than observed for FSH, did not differ by cycle day of GnRH-a initiation. Initial increases in FSH did not differ by cycle day, however, early follicular initiation resulted in a more pronounced suppression of FSH. Mean LH pulse amplitude and frequency increased to a similar extent in all three groups, however, FSH pulse amplitude and frequency varied significantly by cycle day of GnRH-a initiation. Gonadotropin-releasing hormone agonist initiated in the early follicular phase resulted in significant increases in E2, E1, and P levels compared with both midluteal or late luteal. Increases in serum androgens were significantly greater after early follicular and late luteal initiation as compared with midluteal GnRH-a initiation.
Relative FSH suppression and marked androgen elevations in both late luteal and early follicular groups, which may have potential detrimental effects on oocytes of the developing cohort, suggest little advantage of late luteal or early follicular over midluteal initiation of GnRH-a for COH.
在未进行控制性卵巢刺激（COH）的情况下，确定在月经周期的不同阶段给予促性腺激素释放激素激动剂（GnRH-a）后垂体和卵巢的短期激素反应，以确定其对先前已证明会影响辅助生殖技术周期结局的激素参数的独立作用。
对五名月经周期规律的女性进行的前瞻性、随机、对照交叉研究。GnRH-a醋酸亮丙瑞林（LA）从月经周期第3天（卵泡早期）开始，每日皮下注射1 mg，共5天；在促黄体生成素（LH）峰后8天（黄体中期）；或LH峰后13天（黄体晚期）给药。
一家三级医疗中心的临床研究单位。
在月经周期的卵泡早期、黄体中期或黄体晚期开始GnRH-a给药期间，每天测量血清促性腺激素（LH和FSH）和性腺类固醇（E2、雌酮[E1]、P、A和T）。在每个治疗周期中，在GnRH-a给药第2天频繁采集血清样本后，确定促性腺激素脉冲幅度和频率。
血清LH升高幅度比FSH高4至10倍，且不受GnRH-a开始给药的周期日影响。FSH的初始升高不受周期日影响，然而，卵泡早期开始给药导致FSH的抑制更明显。所有三组中，平均LH脉冲幅度和频率升高程度相似，然而，FSH脉冲幅度和频率因GnRH-a开始给药的周期日而有显著差异。与黄体中期或黄体晚期相比，卵泡早期开始使用促性腺激素释放激素激动剂导致E2、E1和P水平显著升高。与黄体中期开始使用GnRH-a相比，卵泡早期和黄体晚期开始使用后血清雄激素的升高显著更大。
黄体晚期和卵泡早期组中相对的FSH抑制和显著的雄激素升高，这可能对发育中的卵母细胞有潜在的有害影响，表明在COH中，黄体晚期或卵泡早期开始使用GnRH-a相对于黄体中期并无明显优势。
