Reproductive outcome using a GnRH antagonist (cetrorelix) for luteolysis and follicular synchronization in poor responder IVF/ICSI patients treated with a flexible GnRH antagonist protocol
Reproductive outcome using a GnRH antagonist (cetrorelix) for luteolysis and follicular synchronization in poor responder IVF/ICSI patients treated with a flexible GnRH antagonist protocol
复制标题
DOI：
10.1016/s1472-6483(10)61685-9
复制
发表时间：
2005-12-01
影响因子：
4
通讯作者：
Lindenberg, S
中科院分区：
文献类型：
--
作者：
Humaidan, P;Bungum, L;Lindenberg, S
为了研究新的刺激方案（称为“CRASH”）对反应不良患者结局的可能有益影响，进行了一项多中心前瞻性纵向研究，共包括36名接受72个IVF/胞浆内单精子注射（ICSI）周期的女性，患者作为其自身对照。不良反应患者定义为从5个或更少卵泡中提取4个或更少卵母细胞，且在之前的长期激动剂下调方案中FSH总消耗量超过2000 IU的患者。CRASH方案包括在周期第23天黄体晚期给予3 mg促性腺激素释放激素（GnRH）拮抗剂西曲瑞克。在周期第2天开始用重组人FSH（rhFSH）刺激，随后是灵活的GnRH拮抗剂方案。结果表明，CRASH方案获得的卵泡数（5.4对3.5）、卵母细胞数（4.3对2.4）和可移植胚胎数（1.8对0.8）均显著高于长方案（P < 0.005）。单次移植的种植率和妊娠率分别为18.4%和38.5%，接近正常反应患者的临床结局。因此，CRASH方案可能构成对低应答患者的常规方案的有吸引力的替代方案，从而改善其临床结果。
To investigate the possible beneficial effect of anew stimulation protocol (termed 'CRASH') on the outcome of poor responder patients, a multicentre, prospective longitudinal study including a total of 36 women undergoing 72 IVF/intracytoplasmic sperm injection (ICSI) cycles with patients serving as their own controls, was conducted. A poor responder patient was defined as a patient with four or fewer oocytes extracted from five or fewer follicles and with a total FSH consumption exceeding 2000 IU in a preceding long agonist down-regulation protocol. The CRASH protocol included 3 mg of the gonadotrophin-releasing hormone (GnRH) antagonist cetrorelix given in the late luteal phase on cycle day 23. Stimulation with recombinant human FSH (rhFSH) started on cycle day 2, followed by a flexible GnRH antagonist protocol. The results showed significantly more follicles (5.4 versus 3.5), oocytes (4.3 versus 2.4) and transferable embryos (1.8 versus 0.8) with the CRASH protocol as compared with the preceding long protocol (P < 0.005 in all cases). The implantation rate and pregnancy rate per transfer was 18.4 and 38.5% respectively, approaching the clinical outcome of normal responder patients. The CRASH protocol thus may constitute an attractive alternative to conventional protocols for low responder patients, improving their clinical outcome.