Schmidt-Sarosi C, Kaplan D R, Sarosi P, Essig M N, Licciardi F L, Keltz M, Levitz M
Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA.
J Assist Reprod Genet. 1995 Mar;12(3):167-74. doi: 10.1007/BF02211793.
To compare the use of human chorionic gonadotropin (hCG) to a gonadotropin releasing hormone (GnRH) agonist, nafarelin, in initiating ovulation and supporting the luteal phase after priming with clomiphene.
In 26 infertile women 50 mg clomiphene citrate produced a preovulatory-size follicle. Then, 11 women were randomized to receive two 400-micrograms doses of nafarelin intranasally 16 h apart, and 15 women were injected intramuscularly with 5000 IU of hCG (luteal day 0 = LD0). Starting on LD6, 7 more 400-micrograms doses of nafarelin were repeated on an every 16-h schedule or a single 2500 IU dose of hCG was given, respectively. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), and hCG were measured. On LD13, endometrium was evaluated with ultrasonography and biopsy in 19 nonpregnant women.
As judged by a threefold rise in serum LH, an LH surge was detected on LD1 in all 11 nafarelin patients, but in only 8 hCG patients (P = 0.01). LH and FSH levels were significantly higher on LD1, 7, and 8 and were significantly suppressed on LD13 in the nafarelin group. All patients had mid-luteal P levels greater than 10 ng/ml and luteal phases longer than 13 days. Significantly different luteal E2 or P levels were noted only on LD13, with lower values in the nafarelin group. Pregnancies were achieved in 3 of 11 nafarelin cycles and 2 of 15 hCG cycles. Luteal phase defects were also similar: 4 of 8 nafarelin patients and 7 of 11 hCG patients.
Nafarelin or hCG in conjunction with clomiphene can result in viable pregnancies, but is associated with low pregnancy rates and a high incidence of luteal phase defects.
比较人绒毛膜促性腺激素（hCG）与促性腺激素释放激素（GnRH）激动剂那法瑞林在克罗米芬预处理后启动排卵及支持黄体期方面的应用效果。
26例不孕女性口服50mg枸橼酸克罗米芬后均产生了排卵前大小的卵泡。然后，11例女性被随机分组，每隔16小时经鼻给予两剂400μg那法瑞林，15例女性肌肉注射5000IU hCG（黄体期第0天=LD0）。从LD6开始，那法瑞林组每隔16小时重复给予7剂400μg那法瑞林，hCG组则给予一剂2500IU hCG。检测血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、孕酮（P）及hCG水平。在LD13，对19例未孕女性进行超声检查及子宫内膜活检。
根据血清LH升高三倍判断，所有11例那法瑞林治疗的患者在LD1时均检测到LH峰，但hCG治疗的患者中仅8例出现（P=0.01）。那法瑞林组在LD1、7和8时LH和FSH水平显著升高，在LD13时显著受到抑制。所有患者黄体中期P水平均大于10ng/ml，黄体期均长于天。仅在LD13时观察到黄体期E2或P水平有显著差异，那法瑞林组的值较低。11个那法瑞林治疗周期中有3例妊娠，15个hCG治疗周期中有2例妊娠。黄体期缺陷情况也相似：那法瑞林治疗的8例患者中有4例，hCG治疗的11例患者中有7例。
那法瑞林或hCG联合克罗米芬可导致成功妊娠，但妊娠率较低且黄体期缺陷发生率较高。
