IVF前週期施予雌激素促使卵泡同步化提高懷孕率

試管嬰兒進入誘導排卵周期前(Previous cycle Day 20 to D2)施予雌激素(4mg/day)10天可促使卵泡生長同步化，提高卵子與胚胎一致性與品質，進而提高懷孕率

http://humrep.oxfordjournals.org/content/18/12/2698.full

Luteal estradiol pre‐treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists

1. Renato Fanchin1,3, 
2. Laurent Salomon1, 
3. Altina Castelo‐Branco1,
4. François Olivennes1, 
5. Nelly Frydman2 and 
6. René Frydman1

+Author Affiliations

1. Departments of
2. ¹Obstetrics and Gynecology and Reproductive Medicine and
3. ²Biology and Genetics of Reproduction, Clamart, France

1. 3To whom correspondence should be addressed at: Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart, France. e‐mail: renato.fanchin@abc.ap‐hop‐paris.fr

• Received July 30, 2003.
• Accepted October 8, 2003.

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Abstract

BACKGROUND: The purpose of this study was to investigate whether luteal estradiol (E₂) administration reduces follicular size discrepancies and enhances ovarian response in recombinant FSH (r‐FSH)/GnRH antagonist protocols. METHODS: We studied prospectively 90 IVF‐embryo transfer (ET) candidates who were randomly pre‐treated with 17β‐E₂ (4 mg/day) from day 20 until next cycle day 2 (E₂ group, n = 47) or served as controls (control group, n = 43). On day 3, all women started r‐FSH treatment. A single 3 mg dose of GnRH antagonist was administered eventually according to follicular maturation. Outcome measures were magnitude of size discrepancy of growing follicles on day 8 of r‐FSH treatment and number of follicles ≥16 mm in diameter on the day of HCG. RESULTS: On day 8, follicles were smaller (9.9 ± 2.5 versus 10.9 ± 3.4 mm,P < 0.001) and their size discrepancies attenuated (P < 0.001) in the E₂ group compared with the control group. This was associated with more ≥16 mm follicles, mature oocytes and embryos in the E₂ group. CONCLUSIONS: Luteal E₂administration reduces the pace of growth, improves size homogeneity of antral follicles on day 8 of r‐FSH treatment and increases the number of follicles reaching maturation at once. Coordination of follicular development optimizes ovarian response to r‐FSH/GnRH antagonist protocols and may constitute an attractive approach to improving their outcome.

Figure 1. Study protocol. Horizontal black bars represent menstrual bleeding. Note that in the luteal E₂ group, r‐FSH treatment was started on the day after 17β‐E₂ discontinuation.

Table I.

Follicular development and embryological results in women pre‐treated or not with E₂ during the luteal phase

	Luteal E2 group	Control group	P
No. of follicles >10 mm on day 8	16.4 ± 1.0	16.8 ± 0.9	NS
Mean follicular size on day 8 (mm)	9.9 ± 0.2	11.1 ± 0.3	<0.001
CV of follicular sizes on day 8	0.22	0.26	<0.02
Day of GnRH antagonist administration	9.1 ± 0.2	8.5 ± 0.2	<0.01
Day of HCG administration	11.9 ± 0.2	10.8 ± 0.2	<0.001
No. of follicles ≥16 mm on day of HCG	9.9 ± 0.5	7.9 ± 0.5	<0.01
No. of mature follicles	9.3 ± 0.7	7.3 ± 0.5	<0.03
No. of available embryos	6.4 ± 0.6	4.6 ± 0.3	<0.01
No. of embryos transferred	2.6 ± 0.1	2.7 ± 0.1	NS
Clinical pregnancy rates/cycle	34%	25%	NS

CV = coefficient of variation.

Figure 2. Hormonal dynamics during COH in luteal E₂ and control groups. Baseline corresponds to the third day of the cycle (the day after E₂ discontinuation in the luteal E₂ group), before r‐FSH treatment. Days 6 and 8 correspond to the sixth and eighth days of r‐FSH treatment, respectively. Differences in serum E₂ levels between both groups were statistically significantly at baseline (P < 0.001), on day 6 (P < 0.02) and on day 8 (P < 0.03), but not on the day of HCG. Differences in serum progesterone and LH levels between both groups did not reach statistical signification on any observation day.