過高或過低GnRH antagonist劑量會造成LH或progesterone壓制過度或不足
http://humrep.oxfordjournals.org/content/20/2/359.full
Dose-finding study of daily GnRH antagonist for the prevention of premature LH surges in IVF/ICSI patients: optimal changes in LH and progesterone for clinical pregnancy
- Judith A.F. Huirne,
- Andre C.D. van Loenen,
- Roel Schats,
- Joseph McDonnell,
- Peter G.A. Hompes,
- Joop Schoemaker,
- Roy Homburg and
- Cornelis B. Lambalk1
+Author Affiliations
- 1To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, VUMC, P.O.Box 7075, 1007 MB Amsterdam, The Netherlands. Email:cb.lambalk@vumc.nl
- Received February 5, 2004.
- Revision received July 21, 2004.
- Accepted October 15, 2004.
Abstract
BACKGROUND: An optimal range of LH concentrations for achieving pregnancy has not been established. The aim of this study was to investigate the effect of various LH levels induced by different GnRH antagonist doses on IVF outcome. METHODS: This was a prospective, single centre study including 144 IVF patients, stimulated with recombinant FSH from cycle day 2, and co-treated with daily GnRH antagonist (antide/Iturelix) (2 mg/2 ml, 1 mg/ml, 0.5 mg/ml, 0.5 mg/0.5 ml or 0.25 mg/ml) from cycle day 7 onwards. Serum samples were taken three times daily. RESULTS: Clinical pregnancies were only observed within a particular range of change in LH levels. The upper and lower thresholds for the mean LH area under the curve (AUC), adjusted for the baseline LH level before the antagonist was started (LH AUC−S6; S6=stimulation day 6) were −2.2 and 12.4 (IU/l) respectively (a negative value=below baseline levels). There were no clinical pregnancies outside these threshold values. Similar results were found for progesterone, the threshold levels of progesterone AUC−S6 were 3.98 and −1.21 ng/ml. Moreover, there were no pregnancies with progesterone levels >0.26 ng/ml/follicle on the day of hCG. CONCLUSIONS: Excessive or insufficient suppression of LH and progesterone levels during GnRH antagonist administration and high progesterone/follicle on hCG day seems to be associated with impaired clinical pregnancy rates.
Table II.
IVF outcome
| IVF outcome | Antide treatment group (daily dose) | P | ||||
|---|---|---|---|---|---|---|
| A (2 mg/2 ml) | B (1 mg/ml) | C (0.5 mg/ml) | D (0.5 mg/0.5 ml) | E (0.25 mg/ml) | ||
| No. of patients | 30 | 30 | 31 | 23 | 30 | |
| No. of oocytes | 10.8 (6.8) | 10.4 (5.2) | 10.1 (5.1) | 9.9 (4.2) | 10.8 (5.9) | 0.99 |
| No. of metaphase II oocytesa | 7.6 (5.3) | 8.3 (5.3) | 7.9 (4.3) | 5.2 (2.8) | 8.0 (3.5) | 0.45 |
| Fertilization rateb | 0.57 (0.3) | 0.62 (0.2) | 0.65 (0.3) | 0.53 (0.2) | 0.65 (0.3) | 0.20 |
| No. of embryos | 5.5 (4.8) | 5.9 (3.4) | 5.4 (3.5) | 4.5 (3.6) | 6.3 (5.0) | 0.60 |
| No. of good quality embryosc | 3.5 (3.5) | 4.2 (2.5) | 3.3 (2.3) | 2.8 (3.2) | 4.5 (3.5) | 0.05 |
| No. of embryos transferred/embryo transfer | 1.9 (0.5) | 2.1 (0.4) | 2.0 (0.3) | 2.0 (0.3) | 1.9 (0.4) | 0.29 |
| Implantation rated (%) | 6.7 | 13.8 | 16.1 | 7.9 | 8.9 | 0.50 |
| Biochemical pregnanciese (%) | 3 (10.0) | 10 (33.3) | 10 (32.3) | 3 (13.0) | 5 (16.7) | 0.08 |
| Clinical pregnanciesf (%) | 3 (10.0) | 6 (20.0) | 8 (25.8) | 3 (13.0) | 4 (13.3) | 0.48 |
| Ongoing pregnanciesg (%) | 3 (10.0) | 6 (20.0) | 7 (22.6) | 3 (13.0) | 4 (13.3) | 0.65 |
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