卵巢功能不佳誘導排卵優先考慮GnRHantagonist

卵巢功能不佳之病患施行試管&誘導排卵，優先考慮GnRHantagonist
GnRHantagonist優於GnRHa短療程

http://www.sciencedirect.com/science/article/pii/S0015028213031099

Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial 

• Sesh Kamal Sunkara, M.D., M.R.C.O.G.^a, , , 
• Arri Coomarasamy, M.D., M.R.C.O.G.^b, 
• Raef Faris,M.R.C.O.G.^c, 
• Peter Braude, Ph.D., F.R.C.O.G.^a, 
• Yacoub Khalaf, F.R.C.O.G.^a

• ^a Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, London, United Kingdom
• ^b Academic Unit, University of Birmingham, Birmingham Women's Hospital, Birmingham, United Kingdom
• ^c Lister Fertility Clinic, The Lister Hospital London, London, United Kingdom

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Objective

To compare the efficacy of the long GnRH agonist vs. the short GnRH agonist vs. the GnRH antagonist regimens in poor responders undergoing IVF.

Design

Randomized controlled trial.

Setting

Tertiary referral fertility units.

Patient(s)

Women with previous poor ovarian response undergoing IVF.

Intervention(s)

One hundred eleven women were randomized to the long GnRH agonist, short agonist, and antagonist regimens.

Main Outcome Measure(s)

The primary outcome was the number of oocytes retrieved. Secondary outcome measures were gonadotropin consumption, duration of stimulation, cycle cancellation rate, mature oocytes retrieved, fertilization rate, cycles reaching ET, and clinical and ongoing pregnancy rates.

Result(s)

Number of oocytes retrieved was significantly higher with long GnRH agonist compared with the short agonist regimen (4.42 ± 3.06 vs. 2.71 ± 1.60), while there was no significant difference between long agonist and antagonist regimens (4.42 ± 3.06 vs. 3.30 ± 2.91). Duration of stimulation and total gonadotropin dose were significantly higher with long agonist compared with short agonist and antagonist regimens. The ongoing pregnancy rate was 8.1% with long and short agonist regimens and 16.2% with the antagonist regimen.

Conclusion(s)

Long GnRH agonist and antagonist regimens offer a suitable choice for poor responders, whereas the short agonist regimen may be less effective because of fewer eggs retrieved.