臨床結果並無統計差異
http://www.ncbi.nlm.nih.gov/pubmed/24129613
Hum Reprod. 2013 Oct 15. [Epub ahead of print]
Comparison of early versus late initiation of GnRH antagonist co-treatment for controlled ovarian stimulation in IVF: a randomized controlled trial.
Hamdine O, Macklon NS, Eijkemans MJ, Laven JS, Cohlen BJ, Verhoeff A, van Dop PA, Bernardus RE, Lambalk CB, Oosterhuis GJ,Holleboom CA, van den Dool-Maasland GC, Verburg HJ, van der Heijden PF, Blankhart A, Fauser BC, Broekmans FJ; The CETRO trial study group.
Source
Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
Abstract
STUDY QUESTION:
What is the impact of initiating GnRH antagonist co-treatment for in vitro fertilization (IVF) on cycle day (CD) 2 compared with CD 6 on live birth rate (LBR) per started cycle and on the cumulative live birth rate (CLBR)?
SUMMARY ANSWER:
Early initiation of GnRH antagonist does not appear to improve clinical outcomes of IVF compared with midfollicular initiation.
WHAT IS KNOWN ALREADY:
During ovarian stimulation for IVF, GnRH antagonist co-treatment is usually administered from the midfollicular phase onwards. Earlier initiation may improve the follicular phase hormonal milieu and therefore overall clinical outcomes.
STUDY DESIGN, SIZE, DURATION:
This open-label, multicentre randomized controlled trial was conducted between September 2009 and July 2011. A web-based program was used for randomization and 617 IVF-intracytoplasmic sperm injection (ICSI) patients were included.
PARTICIPANTS/MATERIALS, SETTING, METHODS:
Recombinant FSH (150-225 IU) was administered daily from CD 2 onwards in both groups. The study group (CD2; n = 308) started GnRH antagonist co-treatment on CD 2, whereas the control group (CD6; n = 309) started on CD 6.
MAIN RESULTS AND THE ROLE OF CHANCE:
There were no significant differences in clinical outcomes between the two groups. A non-significant trend towards a higher LBR per started cycle and CLBR was observed in the CD6 group compared with the CD2 group (LBR: 24.0 versus 21.5%, P = 0.5; CLBR: 29.9 versus 26.7%, P = 0.6).
LIMITATIONS, REASONS FOR CAUTION:
The study was terminated prematurely because no significant difference was observed in clinical outcomes after 617 inclusions. A much larger study population would be needed to detect a small significant difference in favour of either study arm, which raises the question of whether this would be relevant for clinical practice.
WIDER IMPLICATIONS OF THE FINDINGS:
The present study shows that the additional treatment burden and costs of starting GnRH antagonist on CD 2 instead of on CD 6 are not justified, as early initiation of GnRH antagonist does not improve LBRs.
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