Zhang L, Chen G, Liu P
Third Hospital, Beijing Medical University.
Zhonghua Fu Chan Ke Za Zhi. 1996 Aug;31(8):486-9.
To evaluate the efficacy of hormonal therapy for the establishment of endometrium synchronous with the embryo in an oocyte donation and surrogacy fertilization in vitro-embryo transfer (IVF-ET) program.
The IVF-ET routine of the Beijing Medical University was employed. The recipients included cases with (1) premature menopause and (2) abnormal chromosomal karyotypes; surrogate mothers. For (1) surrogate mother, low constant doses of estradiol (E2) (17-beta estradiol-Estrace or E2 valerate) 2-4 mg was started 3-5 days before the expected menstruation of the donor progesterone (P) was started intramuscularly 30 mg daily from the day of hCG injection, 50 mg from the day of oocyte pick-up, 100 mg from the day of embryo transfer and 150 mg from the day of positive urinary beta-hCG; E2 was maintained at the 4 mg dose. Both E2 and P were continued until after the luteo-placental shift-about 90 to 100 days of pregnancy with gradual tapering doses. The serum E2 and P levels were measured by radioimmunoassay and compared with those of normal pregnancy. For (2) women with normal menstrual periods, the Chinese made gonadotropin-releasing hormone-A (GnRH-A) 400-600 micrograms was given for down-regulation of pituitary and artificial agonadism when at least amenorrhea of two months was achieved and a quiescent state of the endometrium and ovaries was ascertained by vaginal ultrasonography. Then the E2 and P therapy was started as described above. GnRH-A was stopped on the day of hCG injection.
In the hormonal therapy group, the serum E2 levels were quite similar to those of the normal pregnancy, while the P levels were about 3-5 times higher. Two full term deliveries of normal female babies and one in her 36th week of pregnancy were achieved in the premature menopause group. In the normal menstruation group, one was in her 15th week of pregnancy and the surrogate mother was in h34 4 1/2 months of pregnancy.
The proposed hormonal therapy to synchronize the donor and the recipient may be used with satisfactory clinical outcome in an oocyte donation and surrogacy IVF-ET program.
评估在卵母细胞捐赠及代孕体外受精 - 胚胎移植（IVF - ET）项目中，激素疗法使子宫内膜与胚胎同步的疗效。
采用北京医科大学的IVF - ET常规方法。接受者包括：（1）过早绝经者和（2）染色体核型异常者；代孕母亲。对于（1）代孕母亲，在供体预期月经前3 - 5天开始低剂量持续给予雌二醇（E2）（17 - β雌二醇 - 爱斯妥或戊酸雌二醇）2 - 4毫克，从注射hCG当天开始每日肌肉注射黄体酮（P）30毫克，取卵当天50毫克，胚胎移植当天100毫克，尿β - hCG阳性当天150毫克；E2维持在4毫克剂量。E2和P均持续至黄体 - 胎盘转换后——妊娠约90至100天，剂量逐渐递减。采用放射免疫分析法测定血清E2和P水平，并与正常妊娠者进行比较。对于（2）月经周期正常的女性，给予国产促性腺激素释放激素 - A（GnRH - A）400 - 600微克以抑制垂体功能并造成人工闭经，当至少出现两个月闭经且通过阴道超声确定子宫内膜和卵巢处于静止状态时，然后按上述方法开始E2和P治疗。GnRH - A在注射hCG当天停用。
在激素治疗组中，血清E2水平与正常妊娠者相当，而P水平约高3 - 5倍。过早绝经组有两名正常女婴足月分娩，一名妊娠36周。在月经周期正常组中，一名妊娠15周，代孕母亲妊娠4个半月。
在卵母细胞捐赠及代孕IVF - ET项目中，所提出的使供体和受体同步的激素疗法临床效果良好。
