The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study
The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study
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DOI：
10.1016/j.fertnstert.2007.02.002
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发表时间：
2008-01-01
影响因子：
6.7
通讯作者：
Benadiva, Claudio
中科院分区：
文献类型：
--
作者：
Engmann, Lawrence;DiLuigi, Andrea;Benadiva, Claudio
目的：确定在接受IVF的高危患者中，使用由GnRH激动剂触发剂与GnRH拮抗剂联合治疗或hCG触发剂双重垂体抑制方案组成的方案，卵巢过度刺激综合征（OHSS）的发生率和植入率是否存在任何差异。设计图：前瞻性随机对照试验。设置：大学三级生育中心。患者：66例40岁以下的多囊卵巢综合征、多囊卵巢形态或既往接受IVF的高反应患者。干预：患者随机接受促排卵方案，包括GnRH激动剂触发剂和GnRH拮抗剂联合治疗（研究组）或GnRH激动剂双重垂体抑制后hCG触发（对照组）。两组均在黄体期及早孕期肌注孕酮（P），研究组同时给予E-2贴剂，并根据血清水平调整剂量。主要结局指标：OHSS的发生率和种植率。结果：研究组中没有患者发生任何形式的OHSS，而对照组中有31%（10/32）的患者发生OHSS。在植入方面没有显著差异（22/61 [36.0%] vs. 20/64 [31.0%]），临床妊娠（17/30 [56.7%] vs. 15/29 [51.7%]）和持续妊娠率（16/30 [53.3%] vs. 14/29 [48.3%]）。结论：使用由GnRH激动剂触发剂和GnRH拮抗剂联合治疗以及适当的黄体期和早期妊娠组成的方案，补充2和P可降低接受IVF的高fisk患者发生OHSS的风险，而不影响植入率。
Objective: To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol. Design: Prospective randomized controlled trial.Setting: University-based tertiary fertility center.Patient(s): Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF.Intervention(s): Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E-2 patches and their doses were adjusted according to the serum levels. Main Outcome Measure(s): Incidence of OHSS and implantation rate.Result(s): None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively.Conclusion(s): The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E-2 and P supplementation reduces the risk of OHSS in high-fisk patients undergoing IVF without affecting implantation rate.