Sher G, Salem R, Feinman M, Dodge S, Zouves C, Knutzen V
Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Reno.
Obstet Gynecol. 1993 Jun;81(6):1009-11.
To evaluate a new method for preventing the life-endangering complications associated with inadvertent menotropin-induced severe ovarian hyperstimulation in patients undergoing in vitro fertilization and embryo transfer (IVF-ET).
Seventeen women each underwent a single cycle of controlled ovarian hyperstimulation with menotropins in preparation for IVF-ET. The indications for IVF-ET were tubal occlusion in nine, endometriosis in six, and unexplained infertility in two. The peak plasma estradiol (E2) concentration before hCG administration was greater than 6000 pg/mL and more than 30 ovarian follicles were detected by transvaginal ultrasound. Thus, life-endangering complications associated with severe ovarian hyperstimulation syndrome were highly likely to occur following hCG administration. Rather than cancel the cycle of treatment, menotropin therapy was discontinued and hCG administration was deferred for a number of days until the plasma E2 concentration fell below 3000 pg/mL ("prolonged coasting"), whereupon hCG was administered and egg retrievals and ETs were duly performed.
None of the women developed severe ovarian hyperstimulation syndrome. There were six viable pregnancies (35.2%), which proceeded normally.
This study indicates that "prolonged coasting" prevents severe ovarian hyperstimulation syndrome in severely overstimulated women undergoing IVF-ET, without necessitating cycle cancellation.
评估一种预防体外受精-胚胎移植（IVF-ET）患者因意外使用促卵泡素导致严重卵巢过度刺激而危及生命的并发症的新方法。
17名女性每人接受了一个周期的促卵泡素控制性卵巢过度刺激，以准备进行IVF-ET。IVF-ET的适应症为9例输卵管阻塞、6例子宫内膜异位症和2例不明原因不孕。注射人绒毛膜促性腺激素（hCG）前血浆雌二醇（E2）峰值浓度大于6000 pg/mL，经阴道超声检测到30多个卵巢卵泡。因此，hCG注射后极有可能发生与严重卵巢过度刺激综合征相关的危及生命的并发症。促卵泡素治疗未取消，而是停药并将hCG注射推迟数天，直至血浆E2浓度降至3000 pg/mL以下（“延长降调节期”），然后注射hCG并适时进行取卵和胚胎移植。
所有女性均未发生严重卵巢过度刺激综合征。有6例活产妊娠（35.2%），妊娠过程正常。
本研究表明，“延长降调节期”可预防严重过度刺激的IVF-ET女性发生严重卵巢过度刺激综合征，而无需取消周期。
