Roest J, Verhoeff A, van Heusden A M, Zeilmaker G H
Department of Obstetrics and Gynaecology, Zuiderziekenhuis, Rotterdam, The Netherlands.
Fertil Steril. 1995 Sep;64(3):552-6. doi: 10.1016/s0015-0282(16)57791-7.
To investigate the feasibility of IVF treatment with minimal monitoring during ovarian hyperstimulation.
Retrospective analysis and prospective study with real-time control group.
Transport IVF program with transport clinic and satellite clinics.
One hundred consecutive IVF cycles monitored at a transport clinic and 100 concurrent consecutive cycles monitored at satellite clinics, using the same stimulation-monitoring protocol and resulting in oocyte aspiration, are compared retrospectively for the number of ultrasound (US) measurements carried out during monitoring and for results of IVF treatment. No patient selection took place. After introduction of a minimal monitoring protocol at a transport clinic, a prospective study was started comparing 100 minimal monitoring cycles at a transport clinic with 100 concurrent conventional monitoring cycles at satellite clinics, all resulting in oocyte aspiration. Patients entered the retrospective or prospective study only once. In all cases the same laboratory facility was used. Monitoring of ovarian hyperstimulation was done with US measurements only. Cycles were canceled for impending ovarian hyperstimulation syndrome (OHSS) when > 35 follicles were seen to develop during hyperstimulation.
Retrospective analysis shows no difference for the average number of US measurements at transport and satellite clinics (2.8 +/- 0.9 and 3.0 +/- 1.0; mean +/- SD). No differences were found in the number of ongoing pregnancies obtained in the two groups: 22 and 18, respectively. One case of severe OHSS occurred in the satellite clinic group. Introduction of minimal monitoring at the transport clinic gives a significant reduction of the average number of US measurements at the transport clinic compared with satellite clinics, where conventional monitoring continued to be used (1.5 +/- 0.8 versus 2.8 +/- 0.9). Ongoing pregnancies at transport and satellite clinics numbered 33 and 26, respectively. In both groups one patient developed severe OHSS. Sixty-two percent of cycles at the transport clinic were monitored with one US measurement only. No cancellations for impending OHSS occurred during the study period.
A large group of patients need only one US measurement during monitoring of ovarian hyperstimulation. Minimal monitoring gives a useful further simplification of the clinical phase of IVF treatment, without adverse effects on treatment outcome and incidence of OHSS.
探讨在卵巢过度刺激过程中进行最少监测的体外受精（IVF）治疗的可行性。
回顾性分析及设立实时对照组的前瞻性研究。
设有转运诊所及卫星诊所的转运IVF项目。
对在转运诊所监测的100个连续IVF周期和在卫星诊所监测的100个同期连续周期进行回顾性比较，两组使用相同的刺激监测方案并均进行了卵母细胞抽吸，比较监测期间超声（US）测量次数及IVF治疗结果。未进行患者选择。在转运诊所引入最少监测方案后，开展前瞻性研究，比较转运诊所的100个最少监测周期与卫星诊所同期的100个传统监测周期，所有周期均进行了卵母细胞抽吸。患者仅参与一次回顾性或前瞻性研究。所有病例均使用相同的实验室设施。仅通过US测量监测卵巢过度刺激。当在过度刺激过程中发现有超过35个卵泡发育时，因即将发生卵巢过度刺激综合征（OHSS）而取消周期。
回顾性分析显示，转运诊所和卫星诊所的平均US测量次数无差异（分别为2.8±0.9和3.0±1.0；均值±标准差）。两组获得的持续妊娠数无差异，分别为22例和18例。卫星诊所组发生1例严重OHSS。与继续使用传统监测的卫星诊所相比，转运诊所引入最少监测后，转运诊所的平均US测量次数显著减少（1.5±0.8对2.8±0.9）。转运诊所和卫星诊所的持续妊娠数分别为33例和26例。两组各有1例患者发生严重OHSS。转运诊所62%的周期仅进行了1次US测量。研究期间未因即将发生OHSS而取消周期。
一大组患者在卵巢过度刺激监测期间仅需进行1次US测量。最少监测可进一步有效简化IVF治疗的临床阶段，且对治疗结局和OHSS发生率无不良影响。
