血清抑制素水平在体外受精-胚胎移植超排卵周期中预测卵巢反应性的价值

目的探讨血清抑制素水平在体外受精-胚胎移植(IVF-ET)超排卵周期中与卵巢反应性的相关性及其预测价值。方法对37例初次接受IVF-ET、基础卵泡刺激素(FSH)水平<12U/L的患者,于IVF前1周期月经第2~4天及黄体中期、IVF周期重组rFSH注射第5天、人绒毛膜促性腺激素(hCG)注射日、取卵日及黄体中期,分别检测血清雌二醇、孕酮、抑制素(INH)A及INHB水平。根据IVF周期中的获卵数、雌二醇峰值水平、是否发生卵巢过度刺激综合征(OHSS)的情况,将37例患者分为卵巢低反应者8例(A组)、卵巢正常反应者及卵巢高反应者29例(B组),比较两组IVF-ET临床效果及注射rFSH前后INH、雌二醇及孕酮水平的变化。通过多重逻辑回归分析、受试者工作特征曲线分析,评价各激素水平预测卵巢反应性的准确性;通过敏感度、特异度的计算确定INHB诊断的临界值。结果(1)A、B组IVF前1周期月经第2~4天INHB水平分别为(37±35)、(91±90)ng/L;IVF周期注射rFSH第5天的INHB水平分别为(194±157)、(2254±4765)ng/L,INHA水平分别为(36±35)、(91±90)ng/L,两组比较,差异有统计学意义(P<0·05)。(2)获卵数与IVF前1周期月经第2~4天INHB水平、IVF周期rFSH注射后各阶段的INHB、INHA及雌二醇水平呈显著正相关(INHB:r=0·39~0·67,P<0·05;INHA:r=0·43~0·59,P<0·01;雌二醇:r=0·50~0·60,P<0·01)。(3)受试者工作特征曲线分析显示,注射rFSH第5天的INHB水平的最大的曲线下面积为0·948(95%可信限为0·871~1·025),将INHB为400ng/L作为临界值时,其对卵巢反应性的预测敏感度为82·8%,特异度为99·1%。结论基础INHB水平、IVF周期rFSH注射第5天的INHB水平均是预测卵巢反应性较好的标记物;IVF周期rFSH注射第5天的INHB水平对卵巢反应性具有最佳的预测价值。     

超排卵治疗中VEGF和E2对OHSS的预测作用

目的　检测超排卵治疗的不孕症患者血清血管内皮生长因子 (VEGF)和雌二醇 (E2 )水平 ,探讨VEGF和E2 对卵巢过度刺激综合征 (OHSS)的预测作用。方法　采集 4 1例高危患者注射HCG前和注射后 34～ 36h血清标本 ,测定VEGF和E2 水平 ,并与同期 30例非高危病人进行对照。结果　高危各组在注射HCG前 ,血清VEGF水平与对照组无显著性差别 (P >0 0 5 ) ,注射后OHSS组VEGF水平明显升高 (P <0 0 1) ,显著高于对照组和非OHSS组 (P <0 0 1) ;高危各组E2 水平在注射HCG日显著高于对照组 ,注射后OHSS组E2 水平与注射前比明显升高 (P <0 0 1) ,显著高于对照组 (P <0 0 1) ,但非OHSS组变化不明显 (P >0 0 5 )。结论　VEGF在HCG注射后可作为预测OHSS的标志物 ,结合连续测定E2 水平 ,有助于预测和治疗卵巢过度刺激综合征。     

血清Δ抑制素B水平与体外受精/卵胞浆内单精子注射周期卵巢反应的关系

目的 探讨卵巢储备功能正常不孕女性血清Δ抑制素B（Δinhibin B,ΔINHB）水平与卵巢刺激后获卵数的关系,以及预测卵巢低反应和高反应的临界值。方法 通过回顾性队列研究,纳入2021年12月至2022年3月在北京大学第三医院妇产科生殖医学中心633例行体外受精/卵胞浆内单精子注射（IVF/ICSI）拮抗剂方案卵巢功能正常的不孕女性,用重组人卵泡刺激素（r-HFSH）或重组卵泡刺激素（r-FSH）+重组黄体生成素（rLH）进行卵巢刺激,在刺激的前5d接受固定剂量的rFSH,使用促性腺激素（Gn）的D1和D5检测血清INHB,两者之差为ΔINHB。主要结局变量是不同时间点INHB与获得卵母细胞数量之间的相关性,以及预测卵巢低反应和高反应的临界值。结果 血清ΔINHB浓度与获卵数呈正相关（Spearman相关系数r=0.587,P<0.001）。预测卵巢低反应和正常反应时,低反应组ΔINHB的临界值是295.5ng/L,敏感度、特异度和约登指数分别是78.9%、75.2%和0.541;预测高反应和正常反应时ΔINHB的临界值是515.5ng/L,敏感度、特异度和约登指数分别是74...     

超排卵治疗中VEGF和E2对OHSS的预测作用

目的检测超排卵治疗的不孕症患者血清血管内皮生长因子(VEGF)和雌二醇(E2)水平,探讨VEGF和E2对卵巢过度刺激综合征 (OHSS)的预测作用.方法采集41例高危患者注射HCG前和注射后34～36h血清标本,测定VEGF和E2水平,并与同期30例非高危病人进行对照.结果高危各组在注射HCG前,血清 VEGF水平与对照组无显著性差别(P>0.05 ),注射后 OHSS组VEGF水平明显升高 (P< 0.01),显著高于对照组和非OHSS组(P< 0.01);高危各组 E2水平在注射HCG日显著高于对照组,注射后OHSS组E2水平与注射前比明显升高(P<0.01),显著高于对照组(P<0.01),但非OHSS组变化不明显(P>0.05).结论 VEGF在HCG注射后可作为预测OHSS的标志物,结合连续测定E2水平,有助于预测和治疗卵巢过度刺激综合征.     

对卵巢高反应者促排卵方案的选择

卵巢的反应性与患者年龄、基础窦状卵泡数目、基础血清卵泡刺激素（FSH）值、血清抑制素B、抗苗勒管激素以及卵巢的体积等密切相关。卵巢高反应者从字面上来理解即是指对于促排卵药物高度敏感的患者。有学者认为在体外受精-胚胎移植（IVF-ET）周期中获卵〉10～14个即为高反应者。另有学者认为HCG日血清E2〉20000pmol／L即为高反应者。但大多数学者均认为卵巢高反应者通常是指卵巢呈多囊卵巢（PCO）改变或是多囊卵巢综合征（PCOS）患者。此类患者对各种促排卵药物的反应常常过激，易出现卵巢过度刺激综合征（ovarianhyperstimulationsyndrome，OHSS）及多胎妊娠。为了追求理想促排卵结果及避免OHSS的发生，国内外众多学者对PCOS患者的促排卵方案进行了大量的探索和研究，现综述如下。     

多囊卵巢综合征(PCOS)患者在IVF-ET中发生严重卵巢过度刺激综合征(OHSS)的特点分析

目的:通过总结IVF-ET中多囊卵巢综合征(PCOS)患者应用控制性超促排卵(COH)后发生卵巢过度刺激综合征(OHSS)的特点,提出防止中、重度OHSS发生的有效措施。方法:将IVF/ICSI治疗时出现中、重度OHSS的患者根据有无PCOS史分成PCOS组和对照组。比较分析PCOS组和非PCOS组在COH中的雌激素水平、卵泡数、取卵数及发生中、重度OHSS的时间等临床资料;分析妊娠对OHSS的影响。结果:PCOS组的Gn用药总量及hCG注射日的血清E2水平比对照组低,其总卵泡数、中小卵泡数明显高于对照组,发生中、重度OHSS的时间早,妊娠可能加重OHSS病情发展。结论:卵泡总数、中小卵泡数可作为PCOS患者预测中、重度OHSS独立的重要指标,建议即使取卵前E2水平不高、获卵数不多也考虑行全胚冷冻,以阻止严重的OHSS发生。     

超排卵治疗中VEGF和E2对0HSS的预测作用

目的 检测超排卵治疗的不孕症患者血清血管内皮生长因子(VEGF)和雌二醇(E2)水平，探讨WGF和E2对卵巢过度刺激综合征(0HSS)的预测作用。方法 采集41例高危患者注射HCG前和注射后34-36h血清标本，测定VEGF和E2水平，并与同期30例非高危病人进行对照。结果 高危各组在注射HCG前，血清VEGF水平与对照组无显著性差别(P＞0．05)，注射后0HSS组VEGF水平明显升高(P＜0．01)，显著高于对照组和非0HSS组(P＜0。01)；高危各组E：水平在注射HCG日显著高于对照组，注射后0HSS组E，水平与注射前比明显升高(P＜0．01)，显著高于对照组(P＜0．01)，但非0HSS组变化不明显(P＞0．05)。结论 VEGF在HCG注射后可作为预测0HSS的标志物，结合连续测定E2水平，有助于预测和治疗卵巢过度刺激综合征。     

辅助生殖技术中卵巢过度刺激综合征发生发展预测指标的研究

目的　寻找辅助生殖技术 (ART)中卵巢过度刺激综合征 (OHSS)发生发展的预测指标。方法　比较1998～ 2 0 0 3年ART治疗后 4 5例OHSS和 4 0例非OHSS患者的妊娠结局 ;并根据OHSS发生时间分早发、晚发两组 ,比较组间特征和实验室资料 ,回归分析筛查OHSS发生发展预测指标。结果　HCG注射后发生OHSS的平均时间为 (9 3± 4 7)d。早发组 (尤合并妊娠者 )比晚发组年轻、促性腺激素用量少、多囊卵巢病例多、HCG注射日中小卵泡评分高 ,差异有显著性意义。回归分析发现 :仅中小卵泡评分与OHSS发生时间相关 ;用中小卵泡评分 >2 0分预测早发组OHSS发生的阳性、阴性预测值 ,敏感性、特异性分别为 90 0 %、92 0 %、81 8%、95 8%。OHSS持续时间与是否妊娠或多胎妊娠有关 ,用OHSS持续时间 >7d、≤ 7d、≥ 12d可分别预测早发组妊娠、晚发组未孕和多胎妊娠。结论　早发OHSS与卵巢对外源性HCG过度反应有关 ,HCG日中小卵泡评分可预测OHSS的发生 ;晚发OHSS更多与胚胎种植后产生的内源性HCG有关 ,OHSS持续时间可判断妊娠情况     

血管内皮生长因子在预测卵巢过度刺激综合征中的作用

目的探讨在体外受精-胚胎移植(IVF-ET)周期中血清及卵泡液中血管内皮生长因子(VEGF)水平的变化,及其在预测卵巢过度刺激综合征(OHSS)中的作用.方法收集42例行IVF-ET患者的血清和卵泡液标本,采用定量酶联免疫方法检测血清、卵泡液中VEGF水平,按是否发生OHSS分为OHSS组(10例)及对照组(32例),对两组临床资料、性激素和VEGF水平进行回顾性相关分析.结果 OHSS组血清VEGF水平在月经周期的各个时期均高于对照组,但差异无显著性(P>0.05).OHSS组卵泡液VEGF水平为(1 487.7±365.8) ng/L,较对照组的(1 025.8±474.7) ng/L明显升高;取卵时卵泡数目增多,OHSS组为(10.0±5.9)个,对照组为(6.1±2.3)个;基础黄体生成素(LH),人绒毛膜促性腺激素(hCG)、注射日雌二醇(E2)水平均比对照组高,差异有显著性(P<0.05).结论 OHSS组卵泡液VEGF水平明显高于对照组,提示VEGF可能参与了OHSS的发病;卵泡液VEGF水平可以作为预测OHSS发生的检测指标.     

卵泡评分系统在IVF-ET中的应用

目的 :检验用体外受精 -胚胎移植 (IVF -ET)周期治疗的患者 ,注射hCG日血清E2 浓度及双侧卵泡分值作为指标预测OHSS发生的可行性。方法 :对 4 0例实施IVF ET的患者分别测定注射hCG日血清E2 和双侧卵泡的大小 ,使用卵泡评分系统 ,探讨卵泡分值与血清E2 水平的相关性以及 2种指标在预测早发型OHSS中的价值。结果 :2种指标的相关系数为 0 .939,以E2 作为指标进行预测 ,阳性预测值和阴性预测值分别为 4 2 9%和 93 6% ,以卵泡分值为指标 ,阳性预测值和阴性预测值分别为 4 0 %和 91 4 %。结论 :卵泡分值与血清E2 水平有良好的相关性 ,二种指标均可预测OHSS的发生     

Updated meta-analysis of recombinant follicle-stimulating hormone (FSH) versus urinary FSH for ovarian stimulation in assisted reproduction

OBJECTIVE: To determine the relative efficacy of recombinant FSH (rFSH) and urinary FSH (uFSH) for ovarian stimulation in assisted reproductive techniques (ART). DESIGN: Systematic review and meta-analysis of randomized, controlled trials comparing rFSH and uFSH. SETTING: Infertility centers providing treatment with ART. PATIENT(S): Patients undergoing IVF with or without ICSI. INTERVENTION(S): Controlled ovarian stimulation using uFSH or rFSH (follitropin alpha or follitropin beta). MAIN OUTCOME MEASURE(S): Primary: rate of clinical pregnancy per cycle. Secondary: rates of spontaneous abortion, multiple pregnancy, and severe ovarian hyperstimulation syndrome (OHSS); total gonadotropin dose; serum E(2) level and number of follicles at hCG administration; number of oocytes retrieved. RESULT(S): Eighteen trials were included in the meta-analysis. Subgroup analyses demonstrated higher pregnancy rates with both follitropins compared with uFSH. However, statistical significance was reached only in the follitropin alpha versus uFSH comparison in IVF cycles, with an additional pregnancy for every 19 patients treated. Fewer units of rFSH than uFSH achieved the same E(2) level and oocyte yield. No differences were found between treatments in rates of spontaneous abortion, OHSS, and multiple gestation. CONCLUSION(S): rFSH produced higher pregnancy rates per cycle than uFSH when follitropin alpha was used in IVF, and the total gonadotropin dose required was lower.     

Pharmacokinetics and follicular dynamics of corifollitropin alfa versus recombinant FSH during ovarian stimulation for IVF

A single injection of corifollitropin alfa can replace seven daily injections of recombinant FSH (rFSH) using a gonadotrophin-releasing hormone antagonist protocol in ovarian stimulation prior to IVF or intracytoplasmic sperm injection. This double-blind randomized controlled trial assessed the pharmacokinetics and pharmacodynamics of 150 μg corifollitropin alfa versus daily 200 IU rFSH in 1509 patients. Comparative analyses were performed on serum concentrations of FSH immunoreactivity (pharmacokinetics), and the number and size of growing follicles, and inhibin B and oestradiol concentrations as biomarkers of ovarian response (pharmacodynamics). The rate of follicular development was similar in both treatment groups. By stimulation day 8, 33% of patients treated with corifollitropin alfa reached the criterion for human chorionic gonadotrophin (HCG) injection. The number of follicles ?11 mm was slightly higher after corifollitropin alfa compared with daily rFSH at stimulation day 8 (difference, 1.2; 95% confidence interval (CI) 0.5–1.8; P < 0.01) and on the day of HCG injection (difference, 2.1; 95% CI 1.4–2.8; P < 0.01). The rise of inhibin B and oestradiol concentrations was similar in both treatment groups. Although the pharmacokinetics of corifollitropin alfa and rFSH are quite different their pharmacodynamic profiles at the dosages used are similar.A single injection of corifollitropin alfa can replace seven daily injections of recombinant FSH (rFSH) using a gonadotrophin-releasing hormone antagonist protocol in ovarian stimulation prior to IVF or intracytoplasmic sperm injection. The objective of this study was to compare the pharmacokinetics and pharmacodynamics of corifollitropin alfa versus daily rFSH. A total of 1509 patients were randomized in a double-blind, controlled trial to either a single injection of 150 μg corifollitropin alfa or to daily injections of 200 IU rFSH for the first 7 days of ovarian stimulation. Serum levels of FSH immunoreactivity were analysed (pharmacokinetic analysis), together with the number and size of growing follicles and serum inhibin B and oestradiol concentrations as biomarkers of the ovarian response (pharmacodynamic analysis). Serum FSH immunoreactivity levels were higher up to stimulation day 5 for corifollitropin alfa compared with the daily rFSH regimen but were similar from day 8 onwards, when patients started rFSH if the criteria for human chorionic gonadotrophin were not yet reached. Corifollitropin alfa treatment resulted in a similar growth rate of follicles though a slightly higher number of follicles were recruited compared with daily rFSH. It is concluded that the pharmacokinetics of corifollitropin alfa and rFSH are quite different but their induced pharmacodynamic effects at the dosages used are similar.     

A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

OBJECTIVE: To compare fixed daily doses of the recombinant FSH (rFSH) Gonal-F (150 IU vs. 225 IU) for ovarian stimulation in IVF-ET. DESIGN: Single-center prospective, randomized study. Assisted conception unit of a university hospital.One hundred twenty-four women aged 23-41 years participated in the study. Exclusion criteria were as follows: FSH of >10 IU/L, polycystic ovarian syndrome, one ovary or previous ovarian surgery, previous poor response to ovarian stimulation, or ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S): Randomized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and total rFSH dose. RESULT(S): More oocytes were retrieved in women aged or=33 years), the number of oocytes retrieved in the two groups were similar. No significant differences were found for fertilization rate, number of embryos formed and cryopreserved, and pregnancy rates between the two groups. The total rFSH dose used was higher in the 225-IU group (2,595.0 +/- 510.0 vs. 1,897.5 +/- 457.5 IU). The cancellation rate due to insufficient ovarian response was higher in the 150-IU group (15.0% vs. 3.3%). All cases of ovarian hyperstimulation syndrome (n = 4) occurred in the 225-IU group. CONCLUSION(S): Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield, suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation.     

Pharmacokinetics and follicular dynamics of corifollitropin alfa versus recombinant FSH during ovarian stimulation for IVF

A single injection of corifollitropin alfa can replace seven daily injections of recombinant FSH (rFSH) using a gonadotrophin-releasing hormone antagonist protocol in ovarian stimulation prior to IVF or intracytoplasmic sperm injection. This double-blind randomized controlled trial assessed the pharmacokinetics and pharmacodynamics of 150 μg corifollitropin alfa versus daily 200 IU rFSH in 1509 patients. Comparative analyses were performed on serum concentrations of FSH immunoreactivity (pharmacokinetics), and the number and size of growing follicles, and inhibin B and oestradiol concentrations as biomarkers of ovarian response (pharmacodynamics). The rate of follicular development was similar in both treatment groups. By stimulation day 8, 33% of patients treated with corifollitropin alfa reached the criterion for human chorionic gonadotrophin (HCG) injection. The number of follicles ≥11 mm was slightly higher after corifollitropin alfa compared with daily rFSH at stimulation day 8 (difference, 1.2; 95% confidence interval (Cl) 0.5-1.8; P < 0.01) and on the day of HCG injection (difference, 2.1; 95% Cl 1.4-2.8; P < 0.01). The rise of inhibin B and oestradiol concentrations was similar in both treatment groups. Although the pharmacokinetics of corifollitropin alfa and rFSH are quite different their pharmacodynamic profiles at the dosages used are similar.     

Does supplementation with recombinant luteinizing hormone prevent ovarian hyperstimulation syndrome in down regulated patients undergoing recombinant follicle stimulating hormone multiple follicular stimulation for IVF/ET and reduces cancellation rate for high risk of hyperstimulation?

Aim of this study was to assess the efficacy of recombinant luteinizing hormone (rLH) supplementation in late follicular phase in multiple follicular stimulation with recombinant follicle stimulating hormone (rFSH) in Triptoreline down-regulated patients undergoing IVF, on preventing clinical OHSS and cycles cancellation for OHSS risk. Nine hundred ninety-nine patients aged ≤40 with basal FSH ≤12 mUI/Ml were down-regulated before starting rFSH stimulation for oocytes recovery. Patients were allocated in two groups: (A) (501 patients) treated with 150 IU of rFSH eventually adjusting rFSH dosage day 7 of stimulation until recombinant human chorionic gonadotropin (rhCG) administration, (B) (498 patients) treated with 150 IU of rFSH and 75 IU of rLH since day 7 of stimulation until rhCG administration and adjusting rFSH at the same day. E2 the day of rhCG was higher in group B (p?<?0.0001); number of cycles cancelled in group A (42/8.3%) for risk of ovarian hyperstimulation syndrome (OHSS) was higher than group B (12/2.4%) (p?<?0.000001). We observed an increase in pregnancies in group B compared with group A (16.8% vs 11.9%) (p?<?0.05) and we observed also a larger number of clinical OHSS in group A than in group B (p?<?0.05).     

Age-matched comparison of recombinant and urinary HCG for final follicular maturation

This age-matched retrospective analysis compared the clinical outcomes of recombinant human chorionic gonadotrophin (rHCG) and urinary HCG (uHCG) in patients undergoing fresh, nondonor IVF cycles. The patients underwent ovarian stimulation by standard gonadotrophin-releasing hormone (GnRH) agonist down-regulation or a GnRH antagonist protocol using recombinant FSH (rFSH) alone or in combination with human menopausal gonadotrophin. When two or more follicles had attained a mean diameter of 20 mm, follicular triggering was achieved with either Ovidrel (rHCG) 250 mug SC or uHCG 10,000 IU IM. Patients receiving rHCG were considered subjects, and they were age-matched in a 1:2 ratio to patients receiving uHCG, who were designated as controls. The main outcome measures were number of oocytes retrieved, number of mature oocytes obtained, number of oocytes fertilized and clinical pregnancy rates. A total of 273 subjects were age-matched and compared with 546 controls. Recombinant HCG had a minimal effect on the number of oocytes retrieved (13.4 versus 13.2), mature oocytes (10.5 versus 10.3) and oocytes fertilized (8.2 versus 7.8) compared with uHCG. Pregnancy (46.0 versus 45.2%) and clinical pregnancy rates (38.1 versus 36.8%) were similar for rHCG and uHCG. Recombinant HCG was as effective as uHCG for final follicular maturation in IVF cycles.     

Results of controlled ovarian stimulation for ART in poor responders according to the short protocol using different gonadotrophins combinations

Introduction Improving pregnancy rates in intricate cases of ovarian stimulation remains a challenge during IVF and intracytoplasmic sperm injection (ICSI). Different protocols of ovulation induction have been proposed.Methods The short protocol of ovarian stimulation using recombinant follicle-stimulating hormone (rFSH) with or without the use of luteinizing hormone (LH) in IVF or ICSI outcome in patients with many failed attempts and maternity age 37 years was investigated. The prognostic significance of high but normal values of day 3 serum FSH concentrations was also evaluated.Results Results show that FSH levels of >9 mIU/ml are associated with poor results even with the use of human menopausal gonadotrophin (HMG). Results were generally comparable when rFSH was used alone or in combination with HMG, except for the quality and the number of embryos transferred, the later being better in the rFSH + HMG group.Conclusion In conclusion intricate cases have good chances for achieving a pregnancy using the short protocol and the outcome is further improved when LH is added from the beginning of ovarian stimulation. A slight elevation of day 3 FSH seems to be a strong prognostic factor for a poor outcome.     

测定血清抑制素B水平预测卵巢储备力及调节控制性超排卵用药的研究

目的探讨血清抑制素B(INHB)水平测定,在评价卵巢储备力和调节控制性超排卵用药中的意义。方法选择96例接受体外受精-胚胎移植(IVF-ET)治疗的患者,根据超排卵用药反应分3组:低度反应组(6例)、中度反应组(72例)、高度反应组(18例)。在经期第3天采用酶联免疫吸附法(ELISA)测定血清INHB水平;采用化学发光法测定血清基础卵泡刺激素(FSH)、黄体生成素(LH)和人绒毛膜促性腺激素(hCG)注射日雌二醇水平;计算周期获卵数、优质胚胎数、周期妊娠率,以调节控制性超排卵用药。结果低度反应组、中度反应组、高度反应组INHB水平分别为(28±20)、(85±42)、(92±34)pg/ml;FSH水平分别为(11·9±5·3)、(7·5±2·6)、(7·2±1·7)U/L;hCG注射日雌二醇水平分别为(2558±2108)、(9366±4472)、(18392±9655)pmol/L;周期获卵数分别为(0·6±0·4)、(8·7±3·6)、(14·3±2·9)个;优质胚胎数分别为(0·4±0·3)、(3·8±1·9)、(4·6±1·7)个;周期妊娠率分别为16·7%、36·1%、61·1%。INHB水平与FSH水平、FSH/LH比值呈负相关(r分别为-0·222,-0·371,P<0·05),与hCG注射日雌二醇水平、周期获卵数、优质胚胎数、周期妊娠率呈正相关(r分别为0·336、0·404、0·323、0·246,P<0·05)。低度反应组、中度反应组、高度反应组在控制性超排卵中,基因重组FSH用量分别为(3808±742)、(3046±709)、(2158±653)U。结论INHB测定可作为预测卵巢储备力的直接指标,在辅助生育治疗中,对指导控制性超排卵用药有重要临床意义。     

Highly purified HMG versus recombinant FSH for ovarian stimulation in IVF cycles

The objective of this study was to compare the live birth rates resulting from ovarian stimulation with highly purified human menopausal gonadotrophin (HP-HMG), which combines FSH and human chorionic gonadotrophin-driven LH activities, or recombinant FSH (rFSH) alone in women undergoing IVF cycles. An integrated analysis was performed of the raw data from two randomized controlled trials that were highly comparable in terms of eligibility criteria and post-randomization treatment regimens with either HP-HMG or rFSH for ovarian stimulation in IVF, following a long down-regulation protocol. All randomized subjects who received at least one dose of gonadotrophin in an IVF cycle (HP-HMG, n = 491; rFSH, n = 495) were included in the analysis. Subjects who underwent intracytoplasmic sperm injection cycles were excluded. The superiority of one gonadotrophin preparation over the other was tested using the likelihood ratio test in a logistic regression analysis. The live birth rate per cycle initiated was 26.5% (130/491) with HP-HMG and 20.8% (103/495) with rFSH (P = 0.041). The odds ratio in favour of HP-HMG was 1.36 (95% confidence interval: 1.01-1.83). Thus, the findings of this integrated analysis demonstrate that ovarian stimulation with HP-HMG, following a long down-regulation protocol, in IVF cycles results in significantly more live births than stimulation with rFSH alone.