月經第7天施打GnRHantagonist

月經第3天施打GnRHantagonist vs. 月經第7天施打GnRHantagonist
懷孕率並無明顯差異

http://humrep.oxfordjournals.org/content/28/12/3227.abstract?sid=f2eb2c03-9a8a-4fb3-9cb7-6099559416fe

Comparison of early versus late initiation of GnRH antagonist co-treatment for controlled ovarian stimulation in IVF: a randomized controlled trial

1. O. Hamdine1,*, 
2. N.S. Macklon1,2, 
3. M.J.C. Eijkemans3, 
4. J.S.E. Laven4,
5. B.J. Cohlen5, 
6. A. Verhoeff6, 
7. P.A. van Dop7, 
8. R.E. Bernardus8,
9. C.B. Lambalk9,10, 
10. G.J.E. Oosterhuis11, 
11. C.A.G. Holleboom12,
12. G.C. van den Dool – Maasland13, 
13. H.J. Verburg14, 
14. P.F.M. van der Heijden15,
15. A. Blankhart16, 
16. B.C.J.M. Fauser1, 
17. F.J. Broekmans1, 
18. The CETRO trial study group

+Author Affiliations

1. ¹Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
2. ²Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton SO16 5YA, UK
3. ³Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3848 CG Utrecht, The Netherlands
4. ⁴Division of Reproductive Medicine, Erasmus University Medical Centre, 3015 CE Rotterdam, The Netherlands
5. ⁵Department of Gynecology and Fertility, Isala Clinics, 8025 AB Zwolle, The Netherlands
6. ⁶Department of Gynecology and Fertility, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
7. ⁷Department of Gynecology and Fertility, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
8. ⁸Department of Gynecology and Fertility, Tergooi Hospital, 1261 AN Blaricum, The Netherlands
9. ⁹Division of Reproductive Medicine, VU University Medical Centre, 1081 HZ Amsterdam, The Netherlands
10. ¹⁰Department of Gynaecology-Obstetrics, Centre for Reproductive Medicine of the University Hospital of Ghent, 9000 Ghent, Belgium
11. ¹¹Department of Gynecology and Fertility, Medisch Spectrum Twente Hospital Group, 7511 JX Enschede, The Netherlands
12. ¹²Department of Gynecology and Fertility, Bronovo Hospital, 2597 AX The Hague, The Netherlands
13. ¹³Department of Gynecology and Fertility, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands
14. ¹⁴Department of Gynecology and Fertility, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
15. ¹⁵Department of Gynecology and Fertility, ZGT Almelo, 7609 PP Almelo, The Netherlands
16. ¹⁶Department of Gynecology and Fertility, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands

1. ↵*Correspondence address. Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, F05.126, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, the Netherlands. E-mail: o.hamdine@umcutrecht.nl

• Received June 14, 2013.
• Revision received August 17, 2013.
• Accepted August 20, 2013.

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.