Fisch B, Royburt M, Pinkas H, Avrech O M, Goldman G A, Bar J, Tadir Y, Ovadia J
Infertility and IVF Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel.
Isr J Med Sci. 1996 Dec;32(12):1172-6.
Poor ovarian response to superovulation treatment is observed in a certain group of patients, the so-called 'low responders'. Despite the evolution of sophisticated controlled ovarian hyperstimulation (COH) regimens prior to the in vitro fertilization (IVF), the ideal stimulation protocol for the low responder has yet to be formulated. The objective of this study was to assess the effect of oral contraceptive pills (OCP), administered before the initiation of superovulation, on ovarian response and IVF treatment results in patients with previous 'low response' to exogenous gonadotropin stimulation. The study group comprised 42 patients who had exhibited poor ovarian response to standard superovulation protocols in at least two previous consecutive treatment attempts. Contraceptive pills were administered for 28-42 days and were immediately followed by menotropin treatment. The study group (n=50 cycles) was compared with the control group consisting of previous cycles (n=88) of the same women. Significant differences were noted in peak estradiol levels (983 +/- 739 vs. 517 +/- 249 pg/ml; P <0.01, paired Student's t test) and number of pre-ovulatory follicles between the study and the control groups. Thirty-three of the cycles (66%) reached the stage of ovum pick-up, compared with 22 (25%) of the previous IVF cycles in these women. The mean number of oocytes retrieved was 6.1 +/- 3.0 and 2.4 +/- 1.3 in the study and control groups, respectively (P <0.01; paired Student's t test). Embryo transfer (ET) was performed in 62% of the treatment cycles and resulted in five clinical pregnancies (16.1% per ET). No pregnancies were recorded in the control group. This study demonstrates the beneficial effect of OCP given prior to IVF treatment, and provides an efficient treatment modality for women who consistently respond poorly to standard COH protocols.
在某组患者中观察到对超排卵治疗的卵巢反应不佳，即所谓的“低反应者”。尽管在体外受精（IVF）之前复杂的控制性卵巢过度刺激（COH）方案不断发展，但针对低反应者的理想刺激方案尚未制定出来。本研究的目的是评估在超排卵开始前服用口服避孕药（OCP）对外源性促性腺激素刺激既往“低反应”患者的卵巢反应和IVF治疗结果的影响。研究组包括42名患者，这些患者在至少两次连续的先前治疗尝试中对标准超排卵方案表现出卵巢反应不佳。服用避孕药28 - 42天，随后立即进行促卵泡素治疗。将研究组（n = 50个周期）与由同一女性先前周期（n = 88个）组成的对照组进行比较。研究组和对照组之间在雌二醇峰值水平（983±739 vs. 517±249 pg/ml；P <0.01，配对学生t检验）和排卵前卵泡数量上存在显著差异。这些周期中有33个（66%）进入了取卵阶段，而这些女性先前的IVF周期中有22个（25%）进入该阶段。研究组和对照组中回收的卵母细胞平均数量分别为6.1±3.0和2.4±1.3（P <0.01；配对学生t检验）。62%的治疗周期进行了胚胎移植（ET），并产生了5例临床妊娠（每次ET为16.1%）。对照组未记录到妊娠。本研究证明了IVF治疗前给予OCP的有益效果，并为对标准COH方案持续反应不佳的女性提供了一种有效的治疗方式。
