Development of safe and convenient ovulation induction

不孕妇女使用促性腺激素诱导排卵需要每天到医院注射，并且与多胎妊娠高度相关。我们开发并评估了新的促排卵方法：促卵泡刺激素脉动GnRH（F-G）、慢性低剂量促卵泡刺激素自注射（LD-F）和克罗米芬-二甲双胍（Cl-Met）。研究设计采用前瞻性、随机化和交叉研究。我们比较了F-G和LD-F在10例PCOS患者中的疗效和安全性。LD-F的治疗方案：每日注射FSH，起始剂量为75iu，治疗14天后，如果没有卵泡发育，则增加剂量。F-G方案：每日注射FSH，起始剂量为150iu，当卵泡达到11mm时改为脉动性GnRH给药。两种治疗方法都同样有效。F-G组每周期总住院天数（8.8±1.3天，平均±SE）明显短于LD-F组（17.7±6.6天）（P<0.01）。自体注射LD-F对3例无排卵患者采用自体注射（SI）或住院（AH）进行LD-F检测。两种治疗的所有周期都实现了单次排卵，没有观察到副作用。SI组卵泡成熟的总天数为6.0±1.0天，AH组为17.7±8.0天（p=0.067）。我们比较了Cl和Cl- met在5例克罗米芬（100mg）耐药的PCOS妇女中的疗效和安全性。克罗米芬剂量150 mg/天，二甲双胍剂量750 mg/天（第5天至卵泡成熟）。1 / 4的Cl和4 / 5的Cl- met显示排卵。所有周期均为单次排卵。其中2例（单胎）成功妊娠。总之，这些新方法都是治疗不孕症的安全、全面的方法。

Ovulation induction using gonadotropin for infertile women requires daily attendance to hospital for injection, and is highly associated with multiple pregnancies. We developed and evaluated new method to induce ovulation: FSH-pulsatile GnRH(F-G), chronic low-dose FSH self-injection(LD-F) and clomiphene-metformine(Cl-Met). Study designs were prospective randomized and cross over in all investigations.1. F-GWe compared efficacy and safety between F-G and LD-F in 10 PCOS patients. Schedule of LD-F: Daily injection of FSH was started with a dose of 75 IU and increased after 14 days treatment in case no follicle developed.Schedule of F-G: Daily injection of FSH was started with a dose of 150 IU and switched to pulsatile GnRH administration when follicle reached 11mm. Both treatments were equally effective. Total day of attendance to hospital per cycle was significantly shorter in F-G(8.8± 1.3 days, mean±SE) than in LD-F(17.7± 6.6) (P<0.01).2. LD-F by self-injectionLD-F was performed by self-injection(SI) or by attendance to hospital(AH) to 3 anovulatory patients. All cycles of both treatment achieved single ovulation, and no side effect was observed. Total days of attendance to follicular maturation were 6.0 ±1.0 clays in SI and 17.7± 8.0 days in AH (p=0.067).3. Cl-MetWe compared efficacy and safety between Cl and Cl-Met in 5 clomiphene (100mg)-resistant women with PCOS. Dose of clomiphene was 150 mg/day and dose of metformin was 750 mg/day(day5 to follicular maturation). One out of 4 in Cl, and 4 out of 5 in Cl-Met showed ovulation. All cycles achieved single ovulations. Pregnancies were achieved in 2 of Cl-Met(singletons).In conclusion, all of new methods were safe and comprehensive methods for infertile patients.