Dual trigger with gonadotropin releasing hormone agonist and human chorionic gonadotropin significantly improves live birth rate for women with diminished ovarian reserve
Dual trigger with gonadotropin releasing hormone agonist and human chorionic gonadotropin significantly improves live birth rate for women with diminished ovarian reserve
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DOI：
10.1186/s12958-018-0451-x
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发表时间：
2019-01-04
影响因子：
4.4
通讯作者：
Li, Sheng-Hsiang
中科院分区：
文献类型：
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作者：
Lin, Ming-Huei;Wu, Frank Shao-Ying;Li, Sheng-Hsiang
背景卵巢储备功能下降（DOR）是影响生育治疗后成功活产的最大障碍之一。本研究旨在探讨是否使用一个双触发组成的人绒毛膜促性腺激素（hCG）加促性腺激素释放激素激动剂（GnRH-a）的最终卵母细胞成熟，可以提高IVF周期的结局卵巢储备功能减退的患者MethodsA共427个完整的GnRH拮抗剂下调IVF周期与新鲜胚胎移植（ET）包括在这个回顾性分析。DOR定义为窦卵泡数5和血清抗苗勒管激素水平1.1ng/mL。对照组（n=130）用6500 IU重组人绒毛膜促性腺激素（rhCG）作为触发剂，研究组（n=297）用0.2mg曲普瑞林+6500 IU重组人绒毛膜促性腺激素（rhCG）作为触发剂（73.1% vs. 58.6%）、临床妊娠率（33.0% vs. 20.7%）和活产率（26.9% vs. 14.5%）。此外，双触发组的流产率（17.4% vs. 37.0%）和胚胎移植取消率（6.1% vs. 15.4%）均显著较低。主要的结局指标是每个取卵周期的活产率。次要结局指标为胚胎移植取消率、临床妊娠率、种植率、化学妊娠率和每次取卵周期的流产率。结论GnRH拮抗剂下调IVF-ICSI周期后，GnRH-a和标准剂量hCG双触发最终卵母细胞成熟可显著提高卵巢储备功能下降妇女的活产率、临床妊娠率和受精率。
BackgroundDiminished ovarian reserve (DOR) remains one of the greatest obstacles affecting the chance of a successful live birth after fertility treatment. The present study was set to investigate whether using a dual trigger consisted of human chorionic gonadotropin (hCG) plus gonadotropin releasing hormone agonist (GnRH-a) for final oocyte maturation could improve the IVF cycle outcomes for patients with diminished ovarian reserve.MethodsA total of 427 completed GnRH-antagonist downregulated IVF cycles with fresh embryo transfer (ET) were included in this retrospective analysis. DOR was defined as antral follicle count 5 and serum anti-Mullerian hormone level1.1ng/mL. The control group (n=130) used a 6500IU of recombinant hCG for trigger, and the study group (n=297) used 0.2mg of triptorelin plus 6500IU of recombinant hCG for trigger.ResultsThe dual-trigger group had significantly higher oocyte fertilization rate (73.1% vs. 58.6%), clinical pregnancy rate (33.0% vs. 20.7%) and live birth rate (26.9% vs. 14.5%) when compared to the hCG trigger group. In addition, the abortion rate (17.4% vs. 37.0%) and embryo transfer cancellation rate (6.1% vs. 15.4%) were both significantly lower in the dual trigger group. The primary outcome measure was the live birth rate per oocyte retrieval cycle. Secondary outcome measures were embryo transfer cancellation rate, clinical pregnancy rate, implantation rate, chemical pregnancy rate and abortion rate per oocyte retrieval cycle.ConclusionsDual triggering the final oocyte maturation with GnRH-a and standard dose of hCG can significantly improve the live birth rate, clinical pregnancy rate, and fertilization rate in women with diminished ovarian reserve undergoing GnRH antagonist down-regulated IVF-ICSI cycles.