Shaker A G, Pittrof R, Zaidi J, Bekir J, Kyei-Mensah A, Tan S L
London Women's Clinic, United Kingdom.
Fertil Steril. 1995 Oct;64(4):791-5. doi: 10.1016/s0015-0282(16)57856-x.
To assess the effect of administration of adjuvant IM progestogen to patients undergoing IVF who were not pituitary desensitized after 14 days of GnRH agonist (GnRH-a) administration.
Prospective randomized study.
A tertiary referral center for assisted conception.
Forty-nine patients undergoing 51 IVF treatment cycles.
Patients in whom the endometrial thickness was > 5 mm or who had an ovarian cyst > 15 mm after 14 days of GnRH-a administration were recruited if the serum E2 concentration was > 27.24 pg/mL (> 100 pmol/L). Patients in group 1 (n = 22) received a single IM injection of 100 mg P whereas patients in group 2 (n = 29) did not. Patients in both groups continued to receive SC GnRH-a 500 micrograms/d and had serum E2 levels measured every 3 days until the concentrations were < or = 100 pmol/L.
The number of days of GnRH-a administration from recruitment until serum E2 concentration measured < or = 100 pmol/L, number of cycles with withdrawal bleeding, number of days from recruitment to withdrawal bleeding, total dose of hMG used, number of follicles > 14 mm, number of oocytes, number of embryos, and pregnancy rates per cycle commenced and per ET.
There were no significant differences in all the above parameters except in the mean number of days from recruitment to onset of withdrawal bleeding, which were 5.33 +/- 0.7 (mean +/- SEM) and 8.62 +/- 1.26 days in groups 1 and 2, respectively. The pregnancy rate per ET was higher in group 1 (38.88%) when compared with group 2 (19.04%). However, this difference was not statistically significant.
Adjuvant administration of a single IM injection of progestogen hastens the onset of withdrawal bleeding in patients who are not pituitary desensitized after 2 weeks of administration of SC GnRH-a. It does not appear to affect the length of time the serum E2 concentrations take to reach basal levels or to alter the ovarian responsiveness to exogenous gonadotropins.
评估对在给予促性腺激素释放激素激动剂（GnRH-a）14天后未出现垂体脱敏的体外受精（IVF）患者给予辅助性肌内注射孕激素的效果。
前瞻性随机研究。
一家三级辅助受孕转诊中心。
49例接受51个IVF治疗周期的患者。
在给予GnRH-a 14天后，如果血清雌二醇（E2）浓度>27.24 pg/mL（>100 pmol/L），且子宫内膜厚度>5 mm或卵巢囊肿>15 mm的患者被纳入研究。第1组（n = 22）患者接受100 mg孕激素的单次肌内注射，而第2组（n = 29）患者未接受。两组患者继续接受皮下注射GnRH-a 500微克/天，并每3天测量血清E2水平，直至浓度≤100 pmol/L。
从纳入研究到血清E2浓度测量值≤100 pmol/L期间给予GnRH-a的天数、出现撤退性出血的周期数、从纳入研究到撤退性出血的天数、使用的人绝经期促性腺激素（hMG）总剂量、直径>14 mm的卵泡数、卵母细胞数、胚胎数以及每个开始的周期和每次胚胎移植（ET）的妊娠率。
除了从纳入研究到撤退性出血开始的平均天数外，上述所有参数均无显著差异，第1组和第2组分别为5.33±0.7（平均值±标准误）天和8.62±1.26天。第1组每次ET的妊娠率（38.88%）高于第2组（19.04%）。然而，这种差异无统计学意义。
对在皮下注射GnRH-a 2周后未出现垂体脱敏的患者辅助性单次肌内注射孕激素可加速撤退性出血的发生。它似乎不影响血清E2浓度达到基础水平所需的时间长度，也不改变卵巢对外源性促性腺激素的反应性。
