D7-11施打FSH比D2-6施打FSH可得較高懷孕率

(A)D2-6每天施打FSH 112iu   vs. (B)D7-11每天施打FSH 112iu
結論:
D7-11比D2-6可得較高之懷孕率& E2
2組卵泡數量類似
誘導排卵中期以後應小心避免下降FSH劑量太快或施予過高estrogen導致feedback抑制endogenous FSH, 造成卵泡終止發育

http://humrep.oxfordjournals.org/content/21/11/2941.full

Timing of FSH administration for ovarian stimulation in normo-ovulatory women: comparison of an early or a mid follicular phase initiation of a short-term treatment

1. I. Cedrin-Durnerin¹,³, 
2. N. Massin¹, 
3. J. Galey-Fontaine¹, 
4. H. Bry-Gauillard¹,
5. M. Roger², 
6. N. Lahlou² and 
7. J.N. Hugues²

+Author Affiliations

1. ¹Centre for Reproductive Medicine—Jean Verdier Hospital, Bondy Cedex, AP-HP, University Paris XIII and
2. ²Hormonal Biology, Saint Vincent de Paul Hospital, AP-HP, University Paris VI, Paris, France

1. 3To whom correspondence should be addressed at: Service de Médecine de la Reproduction, Hôpital Jean Verdier, Avenue du 14 Juillet, 93 143 Bondy Cedex, Bondy, France. E-mail: isabelle.cedrin-durnerin@jvr.ap-hop-paris.fr

• Received February 14, 2006.
• Revision received April 28, 2006.
• Accepted May 25, 2006.

Next Section

Abstract

BACKGROUND: In normo-ovulatory infertile women undergoing mild ovarian stimulation out of IVF, FSH stimulation regimen must be carefully adjusted to control the number of recruited follicles and to prevent multiple pregnancies. The aim of this prospective study was to assess the effect of the timing of FSH administration (fixed dose and duration) on the number of large follicles. METHODS: Women were prospectively randomized by means of sealed envelopes to receive daily 112.5 IU recombinant FSH (rFSH), either from cycle day (CD) 2–6 (Group A) or from CD 7–11 (Group B). Hormonal measurements and follicular ultrasound assessments were performed on CD 2, 7 and 12. RESULTS: On CD 12, the development rate of exactly two follicles ≥14 mm in diameter was significantly lower in Group A than in Group B (4% of women versus 42%, P = 0.002). Although the pattern of serum estradiol (E₂) concentrations in Group A displayed a plateau from CD 7, the cancellation rate for overstimulation (more than three follicles ≥14 mm in diameter) was significantly increased (P = 0.009). CONCLUSIONS: Preventing the closure of the FSH window by mid to late follicular phase FSH administration better fulfils the objective of obtaining a limited number of large follicles than surpassing the FSH threshold by an early administration.

Table I.

Characteristics of patients who received daily injections of 112.5 IU recombinant FSH from cycle day 2 to 6 (Group A) or from days 7 to 11 (Group B)

	Group A (n = 24)	Group B (n = 24)	P
Age (years)	30.8 ± 3.8	30.5 ± 3.4	NS
BMI (kg/m2)	21.4 ± 2.8	21.1 ± 2.2	NS
Cycles length (days)	28 ± 1.2	28 ± 1.2	NS
CD 3 FSH (IU/l)	8.2 ± 2.1	7.2 ± 2.7	NS
CD 3 E2 (pg/ml)	41 ± 12	34 ± 17	NS
CD 20 progesterone (ng/ml)	13.3 ± 4.5	15.9 ± 7	NS
Infertility factor			NS
Unexplained infertility	17	14
Moderate male factor	4	6
Cervical factor	3	4

Table III.

Follicular cohort on CD 12

	Group A (n = 24)	Group B (n = 24)	P
Follicles ≥14 mm	(Absent 3)	(Absent 1)	P = 0.002
One	9	11
Two	1	10
Three	6	2
Four or more	5	0
Follicles ≥10 mm			NS
Three or less	13	13
Four to six	5	8
Seven or more	6	3

Table IV.

Outcome of ovarian stimulation

	Group A (n = 24)	Group B (n = 24)	P
Cancellation (% per started cycle)	8 (33.3)	1(4.2)	0.009
On the day of hCG
hCG day	12.4 ± 3.5	12 ± 1.1	NS
E2 (pg/ml)	312 ± 186	489 ± 136	0.006
Follicles >14 mm	1.6 ± 0.9	1.7 ± 0.8	NS
One	11	10
Two	1	9	0.05
Three	5	4
Follicles 10–13 mm	1.1 ± 1.6	1.9 ± 2	NS
Endometrial thickness (mm)	9.1 ± 2.3	9.1 ± 2	NS
Luteal phase
E2 (pg/ml)	217 ± 152	452 ± 448	NS
Progesterone (ng/ml)	16.4 ± 12.9	18.6 ± 6.7	NS
Pregnancies (% per started cycle)	1 (4.2)	5 (20.8)	0.08

• Results are expressed as mean ± SD; NS, non-significant.