Day2 vs Day5誘導排卵抽血結果類似

Day2 或 Day5誘導排卵其抽血結果類似，
Day5誘導排卵卵泡數量少於 Day2誘導排卵

http://jcem.endojournals.org/content/96/4/1122.full

Follicular Phase Endocrine Characteristics during Ovarian Stimulation and GnRH Antagonist Cotreatment for IVF: RCT Comparing recFSH Initiated on Cycle Day 2 or 5

The administration of recFSH starting on day 2 or day 5 of the cycle in a GnRH antagonist protocol for in vitro fertilization/intracytoplasmic sperm injection patients yields a comparable endocrine profile and follicular development.

Context:

Strategies involving mild ovarian stimulation protocols for in vitro fertilization (IVF) might lessen discomfort to the patient and substantially lower complication rates.

Objective:

The objective of the study was to compare the follicular-phase endocrine characteristics and follicular development in patients who started recombinant FSH (recFSH) on cycle day (CD) 2 or CD5 in IVF treatment, using GnRH antagonist as comedication.

Design:

This was a prospective randomized controlled trial in two university centers in Belgium and The Netherlands.

Patients:

Seventy-six IVF/intracytoplasmic sperm injection patients were included in the study.

Interventions:

The control group (CD2) received a standard treatment with 150 IU recFSH from CD2, whereas in the study group (CD5), stimulation was started on d 5 of the cycle. The GnRH antagonist was administered daily from CD6 onward in both treatment arms.

Main Outcome Measure:

Endocrine follicular phase profile during ovarian stimulation was measured.

Results:

Follicular-phase patterns of gonadotropin and steroid concentrations were found to be comparable in both treatment groups, except for serum estradiol being significantly higher in the CD2 group on d 6 of the cycle (295.6 ± 202.5 ng/liter in the CD2 vs. 102.5 ± 47.9 ng/liter in the CD5 group; P < 0.01) and LH being significantly higher in the CD5 group on d 6 of the cycle (1.7 ± 0.7 IU/liter in the CD2 vs. 5.0 ± 2.1 IU/liter in the CD5 group; P < 0.01). With regard to follicular development, there was no difference in the numbers of small follicles (<10 mm), intermediate follicles (10–12 and > 12–14 mm) and large follicles (>14 mm) in both groups.

Conclusions:

This study shows that the administration of recFSH starting on d 2 or d 5 of the cycle in a GnRH antagonist protocol for IVF/intracytoplasmic sperm injection patients yields a comparable endocrine profile and follicular development. Future studies should focus on the design of more patient-tailored ovarian stimulation protocols.

Fig. 2. Box (median values and 25th and 75th percentiles) and whisker (P₅ and P₉₅₎ plots representing FSH (international units per liter), LH (international units per liter), estradiol (E2; nanograms per liter), and progesterone (P; nanograms per milliliter) serum concentrations of both treatment groups. On the x-axis, the days of blood sampling are given (d 2, 6, and 8 of the cycle and day of hCG administration): CD2 group, d 2 (n = 36 patients), d 6 (n = 33 patients), d 8 (n = 33 patients), d of hCG (n = 33 patients); CD5 group, d 2 (n = 40 patients), d 6 (n = 39 patients), d 8 (n = 39 patients), day of hCG (n = 39 patients).