Padilla S L, Dugan K, Maruschak V, Shalika S, Smith R D
Fertility Center of Maryland, Baltimore, USA.
Fertil Steril. 1996 Apr;65(4):796-9. doi: 10.1016/s0015-0282(16)58216-8.
To analyze the effect of high dose human FSH in combination with hMG with a flare-up leuprolide acetate (LA) protocol in patients undergoing IVF at risk for a poor response.
Prospective.
Free-standing ambulatory IVF center.
Two hundred eighty-four patients underwent a LA screening test for IVF. Patients with a lack of flare response were considered at risk for a poor response and underwent ovarian stimulation with the flare-up LA protocol in combination with high dose human FSH and hMG.
The poor responder group was compared with the good responders on the flare-up LA protocol and to patients undergoing ovulation induction with a luteal phase LA protocol. There were 53 poor responder flare-up LA cycles, 177 good responder flare-up LA cycles, and 54 luteal phase LA cycles. The cancellation rate was higher in poor flare-up LA responders (11.3 percent) compared with good flare-up LA responders (1.1 percent) and luteal phase LA cycles (1.8 percent). Peak E2 levels, number of oocytes, and number of embryos were significantly higher in the good flare-up LA responders. Fertilization rate was similar in all groups. Ongoing pregnancy rate per retrieval was 28 percent in good responders, 29 percent in poor responders, and 33 percent in luteal phase LA patients. Only one patient (0.4 percent) was hospitalized for severe ovarian hyperstimulation.
The flare-up protocol with high-dose human FSH and hMG is a very good alternative for patients who are at high risk for a poor response. Although peak E2 and number of oocytes were significantly lower in this group, the patients who responded had the same fertilization and pregnancy rate as the good responders. Cancellation rate remains high in poor responders.
分析大剂量人促卵泡激素（FSH）联合人绝经期促性腺激素（hMG）及激发剂量醋酸亮丙瑞林（LA）方案对体外受精（IVF）时存在低反应风险患者的影响。
前瞻性研究。
独立的门诊IVF中心。
284例患者接受了IVF的LA筛查试验。对缺乏激发反应的患者视为存在低反应风险，并采用激发剂量LA方案联合大剂量人FSH和hMG进行卵巢刺激。
将低反应组与采用激发剂量LA方案的高反应组以及采用黄体期LA方案进行促排卵的患者进行比较。有53个低反应激发剂量LA周期、177个高反应激发剂量LA周期和54个黄体期LA周期。与高反应激发剂量LA组（1.1%）和黄体期LA周期组（1.8%）相比，低反应激发剂量LA组的取消率更高（11.3%）。高反应激发剂量LA组的雌激素峰值（E2）水平、卵母细胞数量和胚胎数量显著更高。所有组的受精率相似。每次取卵的持续妊娠率在高反应组为28%，低反应组为29%，黄体期LA组患者为33%。仅1例患者（0.4%）因严重卵巢过度刺激住院。
大剂量人FSH和hMG的激发方案对于存在低反应高风险的患者是一个非常好的选择。尽管该组的E2峰值和卵母细胞数量显著较低，但有反应的患者与高反应者具有相同的受精率和妊娠率。低反应者的取消率仍然很高。
