Gelety T J, Surrey E S
Division of Reproductive Endocrinology, Cedars-Sinai Medical Center, UCLA School of Medicine 90024, USA.
J Assist Reprod Genet. 1997 Oct;14(9):525-30. doi: 10.1023/a:1021179427139.
We aimed to determine if midluteal GnRH agonist (GnRHa) use prior to controlled ovarian hyperstimulation (COH) results in uniform progesterone and androgen suppression and whether elevations of these hormones occurring early in follicular development may adversely effect the outcome of IVF-ET.
Forty-four COH cycles using midluteal GnRHa were evaluated. Serum gonadotropins (LH and FSH) and gonadal steroids (E2, A, P4, and T) were measured after 10 days of GnRHa administration [cycle day 31 (CD 31)] and again on the day of hCG administration, following COH. Cycle outcomes evaluated were the number of oocytes retrieved, morphologic grade, fertilization, implantation, pregnancy, and spontaneous abortion rates.
Endogenous serum FSH was uniformly suppressed (6.32 +/- 0.47 IU/L) on CD 31, however, LH was not (23.76 +/- 0.76 IU/L). Five and four tenths percent of cycles demonstrated low-level P4 elevations (> or = 0.9 ng/ml), 24.4% demonstrated serum androstenedione levels > or = 600 pg/ml, and 39% of cycles were characterized by serum T levels > or = 200 pg/ml despite evidence of E2 suppression (< or = 30 pg/ml) and the absence of follicular growth by sonography. LH levels were not predictive of incomplete P4 or androgen suppression. Elevations of either P4, A, or T occurring early in the follicular phase were not found to correlate with an impairment in clinical cycle outcome.
Midluteal GnRHa use prior to COH may result in incomplete suppression of circulating progresterone and androgens. However, these relative elevations, occurring early in the development of the follicular cohort, did not appear to affect IVF cycle outcome adversely.
我们旨在确定在控制性卵巢刺激（COH）之前使用黄体中期促性腺激素释放激素激动剂（GnRHa）是否能使孕酮和雄激素得到均匀抑制，以及卵泡发育早期这些激素水平升高是否会对体外受精-胚胎移植（IVF-ET）的结局产生不利影响。
对44个使用黄体中期GnRHa的COH周期进行评估。在GnRHa给药10天后（周期第31天，即CD 31）以及COH后给予人绒毛膜促性腺激素（hCG）当天再次测定血清促性腺激素（促黄体生成素（LH）和促卵泡生成素（FSH））以及性腺甾体激素（雌二醇（E2）、雄烯二酮（A）、孕酮（P4）和睾酮（T））。评估的周期结局包括获卵数、形态学分级、受精、着床、妊娠和自然流产率。
在CD 31时，内源性血清FSH被均匀抑制（6.32±0.47 IU/L），然而，LH未被抑制（23.76±0.76 IU/L）。5.4%的周期显示孕酮水平轻度升高（≥0.9 ng/ml），24.4%的周期显示血清雄烯二酮水平≥600 pg/ml，39%的周期血清睾酮水平≥200 pg/ml，尽管有证据表明E2被抑制（≤30 pg/ml）且超声检查未发现卵泡生长。LH水平不能预测孕酮或雄激素抑制不完全。未发现卵泡期早期P4、A或T水平升高与临床周期结局受损相关。
在COH之前使用黄体中期GnRHa可能导致循环孕酮和雄激素抑制不完全。然而，这些在卵泡群发育早期出现的相对升高似乎并未对IVF周期结局产生不利影响。
