A comparison of three downregulation approaches for poor responders undergoing in vitro fertilization
A comparison of three downregulation approaches for poor responders undergoing in vitro fertilization
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DOI：
10.1016/j.fertnstert.2005.04.053
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发表时间：
2005-11-01
影响因子：
6.7
通讯作者：
Thomas, MA
中科院分区：
文献类型：
--
作者：
Detti, L;Williams, DB;Thomas, MA
目标：评估三种不同的促性腺激素释放激素激动剂（GnRH-a）刺激方案改善接受体外受精（IVF）的低反应者卵巢反应的疗效。设计：回顾性队列研究。设置：辛辛那提大学医学中心生殖健康中心。患者：1999年1月至2004年1月连续就诊的诊断为低反应者的女性。干预：患者在IVF周期中接受了三种不同的刺激方案：[1]停止方案。从黄体中期到月经开始给予GnRH-a 500 μ g，然后从周期第2天开始给予促性腺激素，[2]微剂量爆发：从第2天到hCG给药日，每天两次给予GnRH-a 20 μ g和促性腺激素，或[3]常规剂量爆发：促性腺激素，从第2天开始，GnRH-a 1 mg/d，持续3天，随后250 μ g/d，直至hCG给药日。主要结果测量：卵巢反应、着床率、临床妊娠和分娩率。结果：本研究纳入了61个IVF周期。这些比较均未达到统计学显著性;然而，微剂量组显示出更高的分娩率趋势。需要进行一项更大规模的前瞻性研究，以确定这种趋势是否会导致该患者人群的显著结果。
Objective: To assess the efficacy of three different GnRH agonist (GnRH-a) stimulation regimens to improve ovarian response in poor responders undergoing IVF.Design: Retrospective cohort study.Setting: Center for Reproductive Health at the University of Cincinnati Medical Center.Patient(s): Women diagnosed as poor responders who presented consecutively from January 1999 to January 2004.Intervention(s): Patients underwent three different stimulation regimens during IVF cycles: [1] stop protocol. GnRH-a 500 mu g administered from the midluteal phase to the start of menses, then gonadotropins from day 2 of cycle, [2] microdose flare: GnRH-a 20 mu g administered twice daily with gonadotropins from day 2 to the day of hCG administration, or [3] regular dose flare: gonadotropins beginning with GnRH-a on day 2 at 1 mg/d for 3 days, followed by 250 mu g/d until the day of hCG administration.Main Outcome Measure(s): Ovarian response, implantation rates, clinical pregnancy and delivery rates.Result(s): Sixty-one IVF cycles were included in the study. None of the comparisons reached statistical significance; however, the microdose group demonstrated a trend toward higher delivery rates. A larger prospective study would need to be performed to determine whether this trend leads to a significant finding in this patient population.