Filicori M, Flamigni C, Dellai P, Cognigni G, Michelacci L, Arnone R, Sambataro M, Falbo A
Reproductive Endocrinology Center, University of Bologna, Italy.
J Clin Endocrinol Metab. 1994 Oct;79(4):1215-20. doi: 10.1210/jcem.79.4.7962297.
Pulsatile GnRH (pGnRH) was administered to 292 anovulatory patients in 600 consecutive cycles between February 1984 and February 1993. This represents the largest single pGnRH series ever reported. Patients were divided into the following groups: primary hypogonadotropic amenorrhea (PHA), 73 patients, 161 cycles; other hypogonadotropic hypogonadisms (OHH), 57 patients 107 cycles; multifollicular ovary (MFO), 39 patients 75 cycles; polycystic ovary (PCO), 85 patients 172 cycles; and other hyperandrogenic anovulations (OHA), 38 patients 85 cycles. GnRH was administered iv at a dose of 1.25-20.0 micrograms every 30-120 min; most cycles (505) were performed with a regimen of 2.5-5.0 micrograms GnRH every 60-90 min. In 228 cycles of MFO, PCO, and OHA patients, pGnRH was preceded by GnRH agonist (GnRH-A) suppression. Ovulatory rates were 75%, and pregnancy occurred in 105 cycles (pregnancy rate of 18%/treatment cycle and 23%/ovulatory cycle). Ovulatory and pregnancy rates were higher in PHA, OHH, and MFO and lower in PCO and OHA. Only 4 multiple pregnancies occurred (3.8%), none after GnRH-A suppression. The abortion rate was 30% and was highest in PCO (45%). GnRH-A pretreatment improved ovulatory rates only in PCO (from 49% to 71%; P < 0.001), whereas it had no significant effect on pregnancy and abortion rates in any group. Higher weight and insulin were associated with lower ovulatory and pregnancy rates; higher LH and testosterone were associated with lower ovulatory rates only. We conclude that 1) pGnRH is a highly effective ovulation induction method; 2) pGnRH does not cause ovarian hyperstimulation; 3) low dose pGnRH is associated with a remarkably low incidence of multiple pregnancy; 4) GnRH-A pretreatment improves pGnRH outcome in PCO and further lowers the incidence of multiple pregnancy; 5) pGnRH is associated with relatively elevated abortion rates, particularly in PCO; and 6) pGnRH is less successful in overweight patients and when high baseline LH, testosterone, and insulin levels are present.
1984年2月至1993年2月期间，对292例无排卵患者进行了600个连续周期的脉冲式促性腺激素释放激素（pGnRH）治疗。这是有史以来报告的最大单组pGnRH治疗系列。患者分为以下几组：原发性低促性腺激素性闭经（PHA），73例患者，161个周期；其他低促性腺激素性性腺功能减退（OHH），57例患者，107个周期；多卵泡卵巢（MFO），39例患者，75个周期；多囊卵巢（PCO），85例患者，172个周期；以及其他高雄激素性无排卵（OHA），38例患者，85个周期。以1.25 - 20.0微克的剂量静脉注射GnRH，每30 - 120分钟一次；大多数周期（505个）采用每60 - 90分钟注射2.5 - 5.0微克GnRH的方案。在MFO、PCO和OHA患者的228个周期中，pGnRH治疗前先进行促性腺激素释放激素激动剂（GnRH - A）抑制。排卵率为75%，105个周期发生妊娠（治疗周期妊娠率为18%，排卵周期妊娠率为23%）。PHA、OHH和MFO的排卵率和妊娠率较高，PCO和OHA的较低。仅发生4例多胎妊娠（3.8%），GnRH - A抑制后无多胎妊娠发生。流产率为30%，PCO组最高（45%）。GnRH - A预处理仅使PCO的排卵率提高（从49%提高到71%；P < 0.001），而对任何组的妊娠率和流产率均无显著影响。体重和胰岛素水平较高与排卵率和妊娠率较低相关；LH和睾酮水平较高仅与排卵率较低相关。我们得出结论：1）pGnRH是一种高效的促排卵方法；2）pGnRH不会引起卵巢过度刺激；3）低剂量pGnRH与多胎妊娠的发生率极低相关；4）GnRH - A预处理可改善PCO患者的pGnRH治疗效果，并进一步降低多胎妊娠的发生率；5）pGnRH与相对较高的流产率相关，尤其是在PCO患者中；6）pGnRH在超重患者以及基线LH、睾酮和胰岛素水平较高时效果较差。
