低劑量hCG可使用於早期誘導排卵

低劑量 CG (200iu/d)可使用於早期誘導排卵

http://www.rbej.com/content/7/1/91

"hCG priming" effect in controlled ovarian stimulation through a long protocol

Background

Recently, it has been demonstrated that, in patients down-regulated by GnRH analogues (GnRHa), a short-term pre-treatment with recombinant LH (rLH), prior to recombinant FSH (rFSH) administration, increases the number of small antral follicle prior to FSH stimulation and the yield of normally fertilized embryos. However, no data exist in the literature regarding the potential beneficial effect of "hCG priming" in controlled ovarian hyperstimulation (COH) through a long GnRH-a protocol, which binds the same receptor (LH/hCGR), though it is a much more potent compared to LH. The primary aims of this study were to assess the effect of short-term pre-rFSH administration of hCG in women entering an ICSI treatment cycle on follicular development, quality of oocytes and early embryo development. The secondary endpoints were to record the effects on endometrial quality and pregnancy rate.

Methods

Patients with a history of at least one previous unsuccessful ICSI cycle were randomly assigned into two groups to receive treatment with either a long protocol with rFSH (control group) or a long protocol with rFSH and pre-treatment with hCG (hCG group). In particular, in the latter group, a fixed 7 days course of 200 IU/day hCG was administered as soon as pituitary desensitization was confirmed.

Results

The mean number of oocytes retrieved was not significantly different between the two treatment groups, although the percentage of mature oocytes tended to be higher but not significantly different in hCG-treated patients. The percentage of patients with more than one grade 3 embryos was higher in the pre-treatment group, which also showed a higher pregnancy rate.

Conclusion

All the above clinical observations, in conjunction with previous data, suggest a point towards a beneficial "hCG priming" effect in controlled ovarian hyperstimulation through a long GnRH-a down-regulation protocol, particularly in patients with previous ART failures.

Table 2
Patients' ovarian response based on the administered treatment (mean values, * = p < 0.05).
	Group 1 (r-FSH) n = 27	Group 2 (r-FSH+hCG) n = 19
E2 on day 5 of FSH admin.	259.3 ± 175.8	220 ± 214.4
E2 on day of hCG admin.	1643.5 ± 800.2	2125* ± 1190
E2/follicle on day of hCG admin.	200 ± 98.9	239 ± 116.9
No. of follicles	8 ± 3	10 ± 3
No. of oocytes	7 ± 3	8 ± 2
Mature oocytes (%)	66.7 ± 17	78.9 ± 18
Fertilized oocytes (%)	87.5 ± 12.5	85 ± 15
Embryo quality (%)	47.6	85.3*
Endometrial quality (%)	46.4	61.3*
Pregnancy Rate (%)	31.8	46.2*
Embryo quality is defined as patients with more than one Grade 3 embryos; Endometrial quality is defined as patients with endometrial thickness ≥ 8 mm.