提早施打腦下垂體拮抗劑 臨床結果並無明顯差別

施打rFSH後第1天(約月經第3天)或第6天(約月經第8天)才施打腦下垂體拮抗劑GnRHantagonist
臨床結果，卵泡大小，卵泡數量並無明顯差別

腦下垂體拮抗劑GnRHantagonist主要影響LH及E2值，對FSH或P4並無明顯影響‧

http://jcem.endojournals.org/content/88/12/5632.full

Initiation of Gonadotropin-Releasing Hormone Antagonist on Day 1 as Compared to Day 6 of Stimulation: Effect on Hormonal Levels and Follicular Development in in Vitro Fertilization Cycles

1. Efstratios M. Kolibianakis, 
2. Carola Albano, 
3. Michel Camus, 
4. Herman Tournaye,
5. Andre C. Van Steirteghem and 
6. Paul Devroey

-Author Affiliations

1. Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, 1090 Brussels, Belgium

1. Address all correspondence and requests for reprints to: Efstratios M. Kolibianakis, Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: stratis@easynet.be.

 

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Abstract

The objective of the present study was to assess the effect of altering the timing of GnRH antagonist initiation on the hormonal environment and follicular development in in vitro fertilization cycles. Sixty women undergoing in vitro fertilization participated in a prospective randomized controlled trial. Patients were stimulated with a fixed dose of 200 IU recombinant FSH, starting on d 2 of the cycle, and with GnRH-antagonist, starting either on d 1 (n = 30) or on d 6 of stimulation (n = 30). A significantly lower exposure to LH (P < 0.001) and estradiol (P < 0.001) during the follicular phase was observed in the d-1 group, compared with the d-6 group of antagonist administration. No differences in follicular development were seen between the two groups on either d 6 of stimulation or on the day of human chorionic gonadotropin administration. Similar fertilization rates, implantation rates, and ongoing pregnancy rates per transfer were, in addition, present between the two groups compared. In conclusion, administration of GnRH antagonist on d 1 (compared with d 6) of stimulation is associated with a lower exposure to LH and estradiol, which does not seem to affect follicular development.

TABLE 1.

LH, E2, P, and FSH levels during the follicular phase of IVF cycles stimulated with GnRH antagonists and rec-FSH

	Median (interquartile range)			P
		d 1	d 6
LH IU/liter
d 1	4.4 (2.5)	4.5 (2.0)	0.8
d 3	1.0 (0.6)	2.4 (2.2)	0.001
d 6	0.5 (0.6)	1.9 (2.0)	0.001
d 8	0.8 (1.2)	1.1 (1.4)	0.1
d of hCG	1.0 (1.3)	0.7 (1.4)	0.4
E2 pg/ml
d 1	39 (21)	41 (24)	0.7
d 3	96 (60)	122 (86)	0.01
d 6	280 (176)	528 (548)	0.001
d 8	679 (459)	1075 (836)	0.2
d of hCG	1385 (1095)	1815 (1040)	0.04
P ng/ml
d 1	0.7 (0.2)	0.7 (0.6)	0.5
d 3	0.6 (0.2)	0.6 (0.5)	0.8
d 6	0.6 (0.3)	0.6 (0.6)	0.7
d 8	0.7 (0.3)	0.8 (0.6)	0.3
d of hCG	0.9 (0.6)	1.2 (0.6)	0.2
FSH IU/liter
d 1	7.2 (3.5)	7.3 (3.2)	0.8
d 3	12.0 (3.5)	11.6 (4.6)	0.9
d 6	13.5 (3.5)	13.0 (5.2)	0.7
d 8	14.0 (4.2)	12.9 (4.6)	0.2
d of hCG

FIG. 2.

Proportion of follicles with diameters less than 11 mm, 11 to <15 mm, 15 to <17 mm, and 17 mm or more, on the day of hCG administration, according to GnRH antagonist initiation.

TABLE 3.

Follicular development on d 6 of stimulation and on the day of hCG, according to timing of GnRH antagonist administration

	Median (interquartile range)			P
		d 1	d 6
Day 6
Total follicles ≥ 11	5.0 (5.0)	4.0 (5.5)	0.4
Follicles < 11 mm	7.0 (7.0)	6.0 (5.7)	0.7
Follicles 11–<15	4.0 (4.0)	4.0 (4.2)	0.3
Follicles 15–<17	0.0 (1.0)	0.0 (1.0)	0.8
Follicles ≥ 17	0.0 (0.2)	0.0 (0.0)	0.3
Day of hCG
Total follicles ≥ 11	11.0 (9.2)	12.0 (8.0)	0.4
Follicles < 11	2.5 (6.0)	2.0 (4.0)	0.2
Follicles 11–<15	5.0 (8.2)	5.5 (4.5)	0.6
Follicles 15–<17	2.0 (4.0)	2 (4.0)	0.2
Follicles ≥ 17