濾泡期晚期以低劑量hCG誘導排卵

月經第10-16天，卵泡1cm以上，以低劑量200iuhCG誘導排卵，可達類似FSH誘導排卵效果

降低FSH劑量，亦不會造成過早黃體化

http://humrep.oxfordjournals.org/content/24/11/2910.full

Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study

1. C. Blockeel1,3, 
2. M. De Vos1, 
3. W. Verpoest1, 
4. D. Stoop1, 
5. P. Haentjens2 and
6. P. Devroey1

+Author Affiliations

1. ¹Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
2. ²Centre for Outcomes Research and Laboratory for Experimental Surgery, UZ Brussel, Brussels, Belgium

1. 3Correspondence address. E-mail: christophe.blockeel@uzbrussel.be

• Received December 16, 2009.
• Revision received April 1, 2009.
• Accepted May 20, 2009.

 

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Abstract

BACKGROUND GnRH-antagonist protocols shorten the treatment period and reduce inconvenience for IVF patients. This randomised controlled trial (RCT) further explored whether low-dose hCG can be used clinically to replace recombinant FSH (rFSH) during the late follicular phase in a GnRH-antagonist protocol.

METHODS Seventy ICSI patients undergoing controlled ovarian stimulation (COS) in a GnRH-antagonist protocol was randomized into two groups. The control group received a standard treatment with rFSH (Puregon) plus a GnRH-antagonist, daily from Day 6 of stimulation. In the study group, rFSH was discontinued when six follicles ≥12 mm were observed and estradiol levels were >600 ng/l; rFSH was subsequently replaced by low-dose hCG (200 IU/l daily).

RESULTS Mean values (SD) for dose and duration of rFSH treatment in the control versus low-dose hCG group were 1617 (280) versus 1273 (260) IU rFSH [between-group difference −344, 95% confidence interval (CI) −483 to −205; P < 0.001], and 8.2 (1.6) versus 6.4 (1.3) days (−1.8, −2.6 to −1.1; P < 0.001), respectively. The mean number of metaphase II oocytes of 10.1 versus 8.9 (between-group difference −1.2, 95% CI −3.9 to 1.5) and the ongoing pregnancy rates of 10/35 (29%) versus 13/35 (37%) (between-group difference 8.6%; 95% CI −13.0 to 29.1%; P = 0.45) for control versus hCG, respectively, did not differ.

CONCLUSION In this pilot trial, substitution of rFSH by low-dose hCG in the final days of COS leads to a reduction of FSH consumption whereas ICSI outcome, in terms of oocyte yield and ongoing pregnancy rate, remains comparable to the traditional regimen (ClinicalTrials.gov, trial number: NCT00750100).

Figure 3

Daily serum concentrations (mean and SE) of LH, FSH, HCG, progesterone (Prog) and estradiol (E₂) during the last 4 days of COS.