长、短效GnRH激动剂在控制性超排卵长方案中应用效果比较

目的通过比较短、长效两种GnRH激动剂（gonadropin releasing hormone agonist,GnRH-a）在控制性超排卵长方案中应用效果,探讨同一种药物不同剂型对体外受精-胚胎移植（in vitro fertilization andembryo transfer,IVF-ET）临床结局的影响。方法对使用长方案超排卵实施IVF-ET治疗的患者,根据使用不同剂型的GnRH激动剂,随机分成GnRH-a短效组及长效组。对两组间垂体降调节效果、促排卵过程中激素水平、促性腺激素（Gn）使用剂量、时间及IVF-ET结局进行比较。结果GnRH-a短效组与长效组相比,Gn使用天数及总剂量降低,分别为[（8.58±1.45）d,（10.17±1.4）d]和[（29.52±12.22）支,（38.83±10.95）支],差异具有统计学意义（P〈0.000 1）;短效组HCG日LH水平明显高于长效组,分别为[（2.56±1.71）U/L,（1.34±1.03）U/L,P〈0.000 1];取卵个数低于长效组[（14.68±7.44）个,（19.46±10.60）个,P〈0.005];两组间临床妊娠率、胚胎种植率及流产率,差异均无统计学意义（P〉0.05）,持续妊娠率在短效组明显高于长效组（52.08%,34.21%）,差异有统计学意义（P〈0.05）。结论在控制性超排卵长方案中应用短、长效GnRH激动剂对垂体均有满意的降调节效果,但长效GnRH-a可能对垂体产生过度抑制,导致Gn的用量增加,在超促排卵过程中LH水平过低,持续妊娠率降低。     

长效和短效GnRH-a在IVF/ICSI周期长方案中的应用比较

目的:探讨长效和短效促性腺激素释放激素激动剂(GnRH-a,曲普瑞林)在体外授精/卵细胞浆内单精子注射(IVF/ICSI)周期长方案中的应用及其对临床结局的影响。方法:对排卵正常者采用黄体中期降调长方案,无排卵者行口服避孕药(OC)预处理长方案,根据采用不同的剂型分为长效GnRH-a组和短效GnRH-a组,对两组在应用过程中的检测值进行比较。结果:无论黄体中期降调长方案,还是OC预处理长方案,其长效GnRH-a组的Gn用量和Gn天数,注射绒促性素(HCG)日血孕酮水平均明显高于短效GnRH-a组(P<0.05,P<0.01),长效GnRH-a组妊娠率和种植率明显低于短效GnRH-a组(P<0.05)。两种方案中,长效和短效GnRH-a组间按主导卵泡平均直径范围(≥18mm～≤20mm、>20mm～≤22mm和>22mm)比较,各直径范围中周期所占比例差异无统计学意义(P>0.05)。结论:长方案中使用长效GnRH-a降调比短效会增加Gn用量,使孕酮水平升高,妊娠率和种植率降低,对临床结局有不利影响。     

GnRH激动剂在控制性促排卵中的方案和疗效

正促性腺激素释放激素(gonadotropin-releasing hormone,GnRH)是下丘脑分泌的肽类物质,由10个氨基酸组成,呈脉冲式释放,脉冲频率在卵泡周期中略有不同:早卵泡期94分钟1次,晚卵泡期71分钟1次,黄体晚期216分钟1次;GnRH通过门脉系统进入垂体后与垂体的促性腺激素细胞表面的GnRH受体结合,促进垂体前叶细胞分泌黄体生成素(LH)、卵泡刺     

GnRH激动剂在子宫肌瘤中的应用

子宫肌瘤是育龄妇女中较多见的良性肿瘤,目前以手术治疗为主,在药物治疗方面,ＧｎＲＨ激动剂是近十几年来研究较多的一类药物,在部分围绝经期妇女及在术前选择性使用,有助于肌瘤萎缩,改善贫血和一般状况,反加疗法可以减少副作用,从而延长治疗周期,防止复发。     

长、短效促性腺激素释放激素激动剂在体外受精周期长方案中应用效果比较

目的:探讨长效和短效促性腺激素释放激素激动剂(gonadrotropin releasing hormone agonist,Gn RH-a)在体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期长方案中的应用及其对临床结局的影响。方法:回顾性分析267例接受长方案控制性超促排卵(COH)患者的临床资料,根据使用不同剂型的Gn RH-a分为A组和B组,A组142例采用长效Gn RH-a 1.1 mg或0.9 mg单次肌肉注射行垂体降调节,B组125例采用短效Gn RH-a 0.05 mg/d皮下注射至人绒毛膜促性腺激素(h CG)注射日行垂体降调节;分析比较其IVF-ET结局。结果:启动日Gn使用剂量及患者血清黄体生成素(LH)、雌二醇(E2)水平组间比较无统计学差异(P0.05),A组卵泡刺激素(FSH)水平显著低于B组(P0.001),但均已达到降调节标准。h CG注射日E2、孕酮(P)水平组间比较无统计学差异(P0.05),A组LH水平显著低于B组(P0.001);B组Gn使用时间、总剂量均明显少于A组(P0.001)。垂体降调节药物使用费用B组显著高于A组(P0.001),但总药物费用无统计学差异(P0.05)。获卵数、受精率、卵裂率、优质胚胎率、临床妊娠率、流产率组间均无统计学差异(P0.05)。结论:在COH过程中,长效和短效Gn RH-a方案均能达到垂体降调节作用,且2种方案的IVF-ET临床结局及患者所承受的经济负担无统计学差异。长效Gn RH-a虽然使用方便,但对垂体的抑制程度更深,在随后的超促排卵过程中Gn的使用时间及使用量均比短效Gn RH-a方案增多。     

PCOS患者中GnRH激动剂和拮抗剂方案的应用及疗效

正控制性促排卵(controlled ovarian stimulation,COS)是体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)技术的重要组成部分。通过COS获得的恰当数量的高质量卵子是IVF-ET的基石。从促性腺激素释放激素(Gonadotropin releasing hormone,GnRH)类似物应用于辅助生殖至今,COS方案随着药物的发展逐渐成熟、稳定。根据GnRH类似     

卵泡期长效长方案在卵巢储备良好但前次黄体期短效长方案助孕失败患者中的应用:一项自身对照研究

目的:探讨卵泡期长效长方案对卵巢储备功能良好但前次黄体期短效长方案助孕失败患者的妊娠结局是否有所改善。方法:回顾性分析106例前次黄体期短效长方案助孕失败后行卵泡期长效长方案再次助孕的卵巢储备功能良好(AFC5)患者212个周期的临床资料,按照促排卵方案分为黄体期短效长方案(A组)与卵泡期长效长方案(B组)。结果:Gn启动日E2值、hCG注射日E2值和子宫内膜厚度以及移植胚胎数组间比较均无统计学差异(P0.05)。B组Gn启动日、hCG注射日血LH值和早期流产率均显著低于A组(P0.001),而Gn使用总剂量、Gn使用天数、获卵数、MII卵数、MII卵率、2PN数、可移植胚胎数、胚胎种植率、生化妊娠及临床妊娠率均显著高于A组(P0.001)。结论:在卵巢储备功能良好但前次黄体期短效长方案助孕失败的女性中,再次助孕采用卵泡期长效长方案可显著提高获卵数及卵子质量,并显著提高妊娠率,降低早期流产率,是理想的治疗方案。     

GnRH激动剂在治疗近端输卵管阻塞中的作用

为了了解 Gn RH激动剂 (Gn RHa)在治疗近端输卵管阻塞中的作用 ,作者于加州大学医学中心选择丈夫精液分析正常 ,本人月经周期规律 ,卵泡早期血清 FSH<10 m IU/ L,经腹腔镜或子宫输卵管造影检查诊断为患单侧或双侧近端输卵管阻塞的不孕妇女 2 1例进行前瞻性研究。 2 1例患者随机分为 2组 ,第一组 14例 ,平均年龄 32 .4岁 ,14例中 ,有 2 7侧近端输卵管阻塞 ,其中 1例即单侧近端输卵管阻塞又对侧远端输卵管阻塞。患者于月经周期第 5天内肌肉注射 Gn RHa 3.75 mg,然后每 2 8天肌肉注射一次 ,连续使用 3个月。第二组 7例 ,平均年龄 33.3岁 …     

GnRH拮抗剂在控制性促排卵中的方案和疗效

正促性腺激素释放激素(gonadotropin releasing hormone,GnRH)是下丘脑分泌产生,由10个氨基酸组成的肽类激素,其重要生理作用是促进性腺激素的释放,即黄体生成激素(LH)和卵泡刺激素(FSH)。GnRH拮抗剂(gonadotropin releasing hormone antagonist)能够与垂体的GnRH受体结合,但不发挥生物学作用,以完全阻断内源性GnRH的作用,能快速抑制     

比较长方案与拮抗剂方案在正常反应人群中的应用

目的探讨正常反应人群拮抗剂方案临床妊娠结局及影响因素。方法检索本院生殖中心临床辅助生殖技术管理系统软件(CCRM)数据库,收集2015年1月—2016年1月期间进行体外受精-胚胎移植(IVF-ET)共1 264例采用激动剂长方案(长方案组)与拮抗剂方案(拮抗剂组)超促排卵患者的临床资料,回顾性队列研究分析采用2种不同超促排卵方案患者的临床结局,包括胚胎种植率、临床妊娠率、活产率及中重度卵巢过度刺激综合征(OHSS)发生率等;在此基础上,进一步分析拮抗剂方案组获得妊娠与未获得妊娠患者的临床资料,探讨拮抗剂方案与妊娠相关的因素。结果 (1)拮抗剂组与长方案组患者的基础资料差异无统计学意义(P0.05),胚胎种植率、临床妊娠率、活产率、中重度OHSS发生率组间差异均无统计学意义(P0.05);然而拮抗剂组在促性腺激素(Gn)使用总量[(1 483.84±453.79)IU]、刺激时间[(9.4±1.5)d]、hCG注射日雌激素水平[(15 321.29±7 272.67)pmol/L]显著低于长方案组[(1 616.10±490.04)IU、(9.7±1.6)d、(17 293.82±7 690.00)pmol/L,P0.001],h CG注射日LH水平[(4.28±2.28)IU/L]及孕激素水平[(3.16±2.64)pmol/L]显著高于长方案组[(3.78±1.74)IU/L,(2.51±1.33)pmol/L,P0.001];(2)比较拮抗剂组新鲜周期移植妊娠与未获得妊娠患者临床资料,妊娠组hCG注射日LH水平[(3.49±2.47)IU/L]显著高于未妊娠组[(2.80±1.82)IU/L,P0.05],进一步根据h CG注射日LH水平分为LH2 IU/L组及LH≥2 IU/L两组,显示LH≥2 IU/L组的种植率(47.78%)、临床妊娠率(63.72%)及活产率(58.41%)显著高于LH2 IU/L组(31.51%、45.45%、36.36%,P0.05),但Gn的用药时间[(9.1±1.4)d]、拮抗剂的用量[(1.17±0.23)mg]及用药时间[(4.7±0.9)d]、获卵数[(7.5±3.2)d]显著少于LH2 IU/L组[(9.7±1.5)d、(1.26±0.31)mg、(5.1±1.2)d、(8.6±3.0)d,P0.05]。结论正常反应人群,较长方案刺激排卵,拮抗剂方案更加温和、友好、高效,有效降低患者Gn用药及刺激时间,拮抗剂可以达到与激动剂类似的种植率、妊娠率及活产率,合理控制h CG注射日LH水平可能有利于拮抗剂方案新鲜胚胎移植临床结局。     

Comparing GnRH agonist long protocol and gnrh antagonist protocol in outcome the first cycle of ART

Purpose  

This prospective study evaluated the efficacy of gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison with the GnRH agonist protocol in the first cycle of assisted reproductive technique (ART).     

Luteal blood flow in patients undergoing GnRH agonist long protocol

Ovarian cancer continues to be the most lethal of the gynaecologic malignancies due to the lack of early detection, screening strategies and ineffective therapeutics for late-stage metastatic disease, particularly in the recurrent setting. The gathering of researchers investigating fundamental pathobiology of ovarian cancer and the clinicians who treat patients with this insidious disease is paramount to meeting the challenges we face. Since 2002, the Canadian Conference on Ovarian Cancer Research, held every two years, has served this essential purpose. The objectives of this conference have been to disseminate new information arising from the most recent ovarian cancer research and identify the most pressing challenges we still face as scientists and clinicians. This is best accomplished through direct encounters and exchanges of innovative ideas among colleagues and trainees from the realms of basic science and clinical disciplines. This meeting has and continues to successfully facilitate rapid networking and establish new collaborations from across Canada. This year, more guest speakers and participants from other countries have extended the breadth of the research on ovarian cancer that was discussed at the meeting. This report summarizes the key findings presented at the fifth biennial Canadian Conference on Ovarian Cancer Research held in Toronto, Ontario, and includes the important issues and challenges we still face in the years ahead to make a significant impact on this devastating disease.     

Comparison of GnRH antagonist with long GnRH agonist protocol after OCP pretreatment in PCOs patients

Purpose  

To evaluate the efficacy of GnRH antagonist in comparison with the GnRH agonist protocol in OCP pretreated polycystic ovary syndrome (PCOs) patients undergoing their first ART cycle.     

Low-dose GnRH antagonist protocol is as effective as the long GnRH agonist protocol in unselected patients undergoing in vitro fertilization and embryo transfer

ObjectiveThe present retrospective and controlled comparative study was designed to evaluate the pregnancy rate achieved using a modified, fixed, multiple-dose 0.125 mg gonadotropin-releasing hormone (GnRH) antagonist protocol with the long GnRH agonist protocol as the control group.Materials and methodsOne hundred and twenty unselected women between 30 and 40 years of age, in their first cycle of IVF/ICSI, with a baseline follicle-stimulating hormone (FSH) <10 IU and an antral follicle count >3 were assigned into two groups: (1) the study group received 0.125 mg of cetrorelix daily starting on Day 6 of stimulation; and (2) the control group received leuprolide daily starting in the mid-luteal phase of the preceding cycle. Both groups were given a flexible dose of recombinant FSH for stimulation. An ongoing pregnancy rate of more than 12 weeks was the primary outcome measure of the study.ResultsPrimary and secondary outcomes were comparable in both groups. A shorter duration of stimulation, a lower dosage of recombinant FSH consumption and a thinner endometrium on the day of human chorionic gonadotropin administration were all observed in the GnRH antagonist group.ConclusionA dosage of 0.125 mg GnRH antagonist protocol was effective for these unselected patients during IVF/ET.     

A modified gonadotropin-releasing hormone (GnRH) antagonist protocol failed to increase clinical pregnancy rates in comparison with the long GnRH protocol

The purpose of this prospective randomized study was to compare stimulation characteristics and IVF outcomes of the standard long GnRH agonist protocol for ovarian stimulation with a modified GnRH antagonist protocol. Starting GnRH antagonist in a flexible protocol according to the size of the leading follicle, with simultaneous augmentation of 75 IU recombinant FSH, failed to increase clinical pregnancy rates.     

GnRH antagonist versus long GnRH agonist protocol in poor IVF responders: a randomized clinical trial

Objective

To compare the efficacy of the long GnRH agonist and the fixed GnRH antagonist protocols in IVF poor responders.

Study design

This was a randomized controlled trial performed in the Iakentro IVF centre, Thessaloniki, from January 2007 to December 2011, concerning women characterised as poor responders after having 0–4 oocytes retrieved at a previous IVF cycle. They were assigned at random, using sealed envelopes, to either a long GnRH agonist protocol (group I) or a GnRH antagonist protocol (group II).

Results

Overall 364 women fulfilled the inclusion criteria and were allocated to the two groups: finally 330 participated in our trial. Of these, 162 were treated with the long GnRH agonist protocol (group I), and 168 with the fixed GnRH antagonist protocol (group II). Numbers of embryos transferred and implantation rates were similar between the two groups (P = NS). The overall cancellation rate was higher in the antagonist group compared to the agonist group, but the difference was not significant (22.15% vs. 15.2%, P = NS). Although clinical pregnancy rates per transfer cycle were not different between the two groups (42.3% vs. 33.1%, P = NS), the clinical pregnancy rate per cycle initiated was significantly higher in the agonist compared to the antagonist group (35.8% vs. 25.6%, P = 0.03).

Conclusions

Although long GnRH agonist and fixed GnRH antagonist protocols seem to have comparable pregnancy rates per transfer in poor responders undergoing IVF, the higher cancellation rate observed in the antagonist group suggests the long GnRH agonist protocol as the first choice for ovarian stimulation in these patients.     

GnRH agonists in the treatment of endometriosis

GnRH agonists, synthetic peptide analogs of GnRH, desensitize pituitary receptors for the native molecule, thus causing reversible hypogonadotropic hypogonadism. Numerous clinical studies have suggested that these compounds are efficacious in the treatment of endometriosis, but it is not clear whether they are superior to the other drugs used in treatment of this disease. The frequency of recurrence of pain symptoms at the end of treatment is high and the data on recovery of fertility are conflicting. Long-term administration of GnRH agonists is a safe and well tolerated treatment but its role in the management of endometriosis is still not well defined.