来曲唑/FSH促排卵中GnRHa与hCG诱发卵泡成熟效果的比较

目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。     

基础FSH/LH比值及晚卵泡期LH水平对体外受精-胚胎移植结局的影响

目的:探讨患者基础FSH/LH比值及控制性超促排卵(COH)时降调后hCG注射日血清LH水平对IVF-ET结局的影响及与COH各参数的关系。方法:回顾性分析首次进行IVF/ICSI-ET助孕、应用GnRH-a长方案降调节的不孕妇女,共427个周期。结果:ROC曲线显示FSH/LH比值与IVF-ET临床妊娠率无明显相关性;FSH/LH≥2与FSH/LH<2组间虽然临床妊娠率无差异,但FSH/LH≥2组Gn用量增加,获卵数少,优质胚胎数少,存在统计学差异(P<0.05)。hCG注射日血清LH≥0.65IU/L者妊娠率(55.8%)明显高于LH<0.65IU/L者(24.6%)。结论:基础FSH/LH比值增高能较早反映卵巢储备功能并指导超排方案及Gn用量;降调节后卵泡晚期(hCG注射日)的LH水平过低(<0.65IU/L),将会导致临床妊娠率下降。     

改良超长方案中促排卵时不同时期添加高纯度尿促性素对助孕结局的影响

目的 探讨促性腺激素释放激素激动剂(GnRH-a)改良超长方案促排卵中高纯度尿促性素(HPhMG)不同添加时机和剂量对助孕结局的影响。方法 回顾性分析本中心首次行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)中采用改良超长方案并添加使用了HP-hMG的454例患者的临床资料,根据添加HP-hMG的时机分为全程添加组(A组)和后半期添加组(B组)。A组:Gn启动日血清黄体生成素(LH)1.2 IU/L的患者在重组卵泡刺激素(r-FSH)促排卵的第1日同时添加HP-hMG至hCG注射日;B组:Gn启动日血清LH≥1.2 IU/L的患者r-FSH促排卵的第6日开始添加HP-hMG至hCG注射日。对不同年龄阶段患者(≤35岁和36~40岁)进行分析,观察Gn使用总量和使用时间、hCG注射日激素水平、获卵情况、胚胎质量、着床率、临床妊娠率、活产率、流产率和中重度卵巢过度刺激综合征(OHSS)风险等临床结果。结果 ≤35岁的患者中A组相比B组,虽然Gn使用总量有所增加,但hCG注射日孕酮(P)水平降低,IVF受精率明显增高,差异均有统计学意义(P0.05);着床率分别为58.2%和42.4%,临床妊娠率分别为80.1%和61.7%,活产率分别为68.9%和49.5%,差异均有统计学意义(P0.05)。36~40岁的患者中,A组与B组的临床妊娠率分别为61.9%和26.3%,活产率分别为47.6%和15.8%,差异均有统计学意义(P0.05)。A、B两组在不同年龄段的流产率和中重度OHSS发生率相似。结论 改良超长方案中患者全程添加HP-hMG较后半期添加能降低hCG注射日P水平,显著提高着床率、临床妊娠率和活产率。     

拮抗剂方案中卵泡期促黄体生成素水平对不同卵巢反应者体外受精-胚胎移植结局的影响

目的探寻拮抗剂方案中添加拮抗剂的最佳时机及人绒毛膜促性腺激素(hCG)注射日合理的促黄体生成素(LH)水平区间。方法回顾性队列研究分析1 327例拮抗剂方案的取卵周期资料,根据基础窦卵泡数(AFC)将卵巢反应性依次分为卵巢低反应组(AFC≤5,n=278)、卵巢正常反应组(6≤AFC≤15,n=756)、卵巢高反应组(AFC≥16,n=293),并根据拮抗剂添加日及hCG注射日的LH水平再分组比较临床结局。结果 (1)在拮抗剂添加日,不同卵巢反应者LH5 IU/L及≥5 IU/L组的妊娠结局差异均无统计学意义,但卵巢低反应者在LH≥5 IU/L时开始添加拮抗剂可能获得较高的优质胚胎率,卵巢正常反应者在LH≥5 IU/L时开始添加拮抗剂Gn使用时间较少。(2)在hCG注射日不同卵巢反应者的LH水平对其妊娠结局均无影响。结论拮抗剂添加日LH水平及hCG注射日LH水平均不影响拮抗剂方案的临床妊娠率,但不同卵巢反应者卵泡期适合的LH水平可能有所不同。     

脱氢表雄酮(DHEA)预治疗在体外受精-胚胎移植周期中的应用

目的:探讨脱氢表雄酮(DHEA)预治疗在卵巢储备低下妇女的体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)周期治疗中的作用。方法:对173例卵巢储备功能低下进行IVF/ICSI-ET的患者进行随机对照研究。DHEA预治疗组(n=81)患者口服DHEA,连用3个月,对照组为未服用DHEA预治疗者(n=92)。观察患者的一般情况、超促排卵情况及胚胎发育和妊娠结局。结果:患者一般情况、hCG注射日子宫内膜厚度及E2水平、Gn使用量和Gn使用天数组间均无统计学差异(P>0.05)。DHEA组IVF受精率、优质胚胎率及临床妊娠率均高于对照组(P<0.05)。但在胚胎种植率、早期流产率、周期取消率组间差异无统计学意义(P>0.05)。结论:DHEA预治疗可以改善卵巢储备功能低下妇女的IVF结局。     

克罗米芬联合高孕激素促排卵抑制早发LH峰的临床结局研究

目的:探讨在控制性超促排卵中克罗米芬(CC)联合高孕激素促排卵方案抑制早发LH峰的临床效果。方法:回顾性分析126名行体外受精/卵胞质内单精子显微注射(IVF/ICSI)取卵周期的患者,分为CC联合高孕激素促排卵组(试验组,n=63)和短方案治疗组(对照组,n=63)。观察过早LH峰发生率、促排卵中Gn用量和用药天数、获卵数、成熟卵数、内分泌及胚胎试验室结果。结果:试验组获卵数、成熟卵数、有效胚胎数、生化妊娠率、临床妊娠率、胚胎种植率与对照组比较均无统计学差异(P0.05)。所有对象在促排卵过程中未监测到早发LH峰,试验组月经第9~10日和诱发排卵日LH水平与基础值间无统计学差异(P0.05)。试验组Gn用量和用药天数均高于对照组(P0.05)。结论:CC联合高孕激素促排卵方案可以有效抑制早发LH峰,促排卵过程中LH水平平稳,且可以获得有发育潜能的胚胎。     

克罗米芬与GnRH拮抗剂在控制性超促排卵中抑制LH峰效果的比较

目的:探讨克罗米芬(CC)与GnRH拮抗剂(GnRH-A)在控制性超促排卵(COH)中对黄体生成素(LH)峰抑制效果的比较。方法:对应用CC后置方案和拮抗剂方案的181个周期的资料进行回顾性分析。其中应用CC抑制LH峰方案65例(CC组),应用GnRH-A(思则凯组)抑制LH峰方案116例。比较2种药物对LH峰的抑制作用、Gn用量、获卵数、可移植胚胎数、优质胚胎数、受精率等。结果:hCG注射日LH值与加用CC或思则凯日LH值的差值[LH(d-)]具有统计学差异(1.30±5.12 IU/L vs-1.37±7.15 IU/L,P=0.004);Gn用量、获卵数、可移植胚胎数、优质胚胎数、受精率等CC组和思则凯组比较差异无统计学意义(P0.05)。结论:CC与思则凯对早发LH峰均有一定抑制效果,但较CC相比其抑制早发LH峰效果可能更明显。     

短方案超促排卵后卵泡晚期黄体生成激素对体外受精结局影响的研究

目的 探讨在超促排卵时卵泡晚期血清黄体生成激素(LH)对体外受精结局的影响.方法 回顾性分析2006年5月至10月在北京大学第三医院基础促性腺激素正常的不孕症妇女,212个体外受精.胚胎移植(IVF-ET)周期,均采用超促排卵方案促性腺激素释放激素激动剂(GnRH-a)短方案降调节方案,卵泡刺激素(FSH)225IU/d起进行超促排卵患者,人绒毛膜促性腺激素(HCG)日血清LH水平对IVF妊娠结局的影响.结果 HCG日血清LH≥1.58 IU/L者妊娠率(58.33%)明显高于LH＜1.58 IU/L者(34.48%),比较低LH组(A组)和高LH组(B组)的临床情况发现,A组的Gn用量高(2 218.5IU 对1 938.OIU)、Gn使用时间长(12.32d对11.03d).HCG 日的雌二醇(12 854.96pmol/L对15 022.55pmol/L)、孕酮(3.12nmol/L对3.69nmol/L)水平低,经统计学处理,P均＜0.01.结论 在超促排卵过程中,卵泡晚期的LH水平过低(＜1.58IU/L)将会导致临床妊娠率下降.可能与获卵数多,而相应的雌、孕激素水平较低有关.     

晚卵泡期孕酮水平提前上升相关因素分析及其发生机制的新探讨

目的:探讨晚卵泡期孕酮(P)水平上升对妊娠结局的影响,分析与P水平上升的相关因素并探讨其潜在机制.方法:回顾性分析1 083例IVF/ICSI患者的临床资料.根据hCG注射日血清P水平结合早发性LH峰将患者分为3组:低孕酮LH正常组(A组)、高孕酮LH正常组(B组)、高孕酮LH峰组(C组);根据hCG注射日卵泡数及E2水平将患者分为:卵巢正常反应组、卵巢高反应组.比较各组患者的临床特征、用药情况和妊娠结局.结果:P水平上升的最佳判断点为1.205 ng/ml. A、B和C组的临床妊娠率分别为51.0％、38.9％和28.6％(P=0.000),胚胎种植率分别为32.2％、24.9％和15.6％(P=0.001).与A组相比,B和C组的Gn使用总量更高(P=0.000)、获卵数更多(P=0.000).与B组相比,C组直径≥18mm的卵泡数更少、E2水平更低、P水平上升更高,差异有统计学意义(P＜0.05).与卵巢正常反应组相比,卵巢高反应组同量用药情况下P水平上升更高.孕酮提前上升的相关因素为体质量指数(BMI)、基础FSH、hCG注射日最大卵泡直径、E2水平、Gn使用总量和Gn启动剂量.结论:晚卵泡期P水平提前上升不利于妊娠结局,但不影响卵母细胞及胚胎质量.卵巢自身反应性与FSH剂量是导致P水平提前上升的关键因素.     

在GnRH拮抗剂方案中添加来曲唑对卵巢储备功能低下者体外受精-胚胎移植结局的影响

目的:探讨在促性腺激素释放激素(GnRH)拮抗剂方案中添加来曲唑(LZ),对卵巢储备功能低下者体外受精-胚胎移植(IVF-ET)结局的影响.方法:回顾性分析63个应用LZ结合小剂量促性腺激素(Gn)的IVF周期(Gn+ LZ组)和177个单纯应用大剂量Gn的IVF周期(Gn组)的临床结局.Gn+ LZ组在月经周期第2～6天给予LZ 5 mg/d,于月经周期第5天开始加用Gn 150～ 225 U/d.Gn组在月经周期第2天开始应用Gn 300 ～ 450 U/d.两组均在月经周期的第7天开始给予醋酸西曲瑞克(思则凯)0.25 mg/d,直至HCG日.结果:Gn+ LZ组的周期取消率显著高于Gn组(P=0.005),获卵数显著低于Gn组(P=0.000),但着床率显著高于Gn组(P =0.006).两组的妊娠率、临床妊娠率和继续妊娠率差异无统计学意义(P＞0.05).Gn+LZ组的Gn用量显著低于Gn组(P =0.000).结论:卵巢储备功能低下者在拮抗剂方案中添加LZ可以改善着床率,妊娠结局与应用单纯大剂量Gn相似,同时减少了患者Gn的用量.     

促性腺激素释放激素激动剂长、短方案在体外受精-胚胎移植中的比较性研究

目的　探讨促性腺激素释放激素激动剂（GnRH-a）长、短方案控制性超排卵在体外受精-胚胎移植（IVF-ET）中的疗效。方法　将2000年1～5月进行IVF和单精子卵胞浆注射（ICSI）助孕的不孕患者，按病历奇、偶数编号分为GnRH-a长方案组（55例）和短方案组（54例）。长方案组从使用促性腺激素（Gn）治疗周期前的黄体中期开始使用GnRH-a0.9mg/d，至垂体完全降调节后，加用Gn；短方案组从月经第2天开始使用GnRH-a0.45mg/d，同时加用Gn。两组均在优势卵泡达18mm时，肌内注射人绒毛膜促性腺激素（hCG），36h后取卵行IVF及ICSI。结果　长方案组较短方案组，使用Gn前血清促卵泡激素（FSH）和黄体生成素（LH）水平降低［（4.4±1.2）IU/L比（6.3±1.7）IU/L,（2.7±1.5）IU/L比（4.4±2.8）IU/L,P<0.01］；注射hCG前血清雌二醇（E2）和LH水平降低［（7119±3584）pmol/L比（9523±3587）pmol/L，（1.0±1.0）IU/L比（4.0±3.4）IU/L,P<0.01］；每个卵子E2水平降低［（610±315）pmol/L比（935±450）pmol/L,P<0.01］；Gn用量增多［（28.0±8.6）支比（23.4±8.7）支,P<0.01］，用药时间增长［（11.1±1.2）d比（10.1±1.5）d,P<0.01］；两组平均获卵数、第2次成熟分裂中期卵子数、受精卵数、卵裂数、优质胚胎数及妊娠率无显著差异。结论　在IVF-ET，GnRH-a长、短方案能获得相同的控制性超排卵效果，且GnRH-a短方案能减少Gn用量和缩短治疗时间。     

Effects of low day 3 luteinizing hormone levels on in vitro fertilization treatment outcome.

In a previous study we demonstrated that women with day 3 luteinizing hormone (LH) values < 3 IU/l subjected to controlled ovarian hyperstimulation without pituitary desensitization responded with a lower number of follicles > 15 mm compared to women with a higher basal LH level. The aim of this study was to determine whether in patients with day 3 LH levels < 3 IU/l a further reduction of serum LH concentration by gonadotropin-releasing hormone (GnRH) analog impairs follicular response to follicle stimulating hormone (FSH) and treatment outcome in in vitro fertilization (IVF) cycles. For this purpose we retrospectively studied 249 consecutive women subjected to standard IVF treatment employing pituitary desensitization with buserelin and follicular stimulation with urinary highly purified FSH. The patients were divided into two groups according to their day 3 LH value. The first group (group A) showed day 3 LH levels < 3 IU/l and the second (group B) had day 3 LH levels > 3 IU/l. Group A and B patients did not show statistically significant differences in the ovarian response to FSH, nor in IVF treatment outcome, showing that in FSH treated GnRH analog suppressed cycles, the ovarian responsiveness and IVF outcome do not differ according to basal LH values. However, the high dosage of FSH we employed in group A and B patients could account, at least in part, for this result. Indeed, comparative evaluations with unsuppressed cycles (our previous study) strongly suggest that a reduced ovarian responsiveness to gonadotropins in patients with day 3 LH values < 3 IU/l should be considered in clinical practice.     

IVF中三种促超排卵方案效果的比较

目的：探讨IVF中最佳促超排卵方案。方法：将IVF对象随机分为3组。BFh组：23例126个周期,按BFh长方案（Buserelin／FSH／hCG）进行;Chh组：13例14个周期,以CC／hMG／hCG方案进行;Fhh组：55例57个周期,按FSH／hMG／hCG方案进行。结果：每周期平均促性腺激素（Gn）用量BFh组为18．62±5．95支;Chh组16．57±5．70支;Fhh组25．56±8．08支。每周期获成熟卵子数分别为10．23±5．80个;6．07±3．22个;10．96±6．45个。Gn用量BFh组与Chh组差异无显著性（P＞0．05）,但取到的卵子数,差异有显著性（P＜0．05）。BFh组与Fhh组比较,BFh组Gn用量少于Fhh组（P＜0．05）,但取到的卵子数差异无显著性（P＞0．05）,且BFh组无过早的LH峰出现,另二组则各有1例过早的出现内源性LH峰。结论：IVF中BFh方案是较为理想的促起排卵方案。     

Effects of low day 3 luteinizing hormone levels on in vitro fertilization treatment outcome

In a previous study we demonstrated that women with day 3 luteinizing hormone (LH) values < 3 IU/l subjected to controlled ovarian hyperstimulation without pituitary desensitization responded with a lower number of follicles > 15 mm compared to women with a higher basal LH level. The aim of this study was to determine whether in patients with day 3 LH levels < 3 IU/l a further reduction of serum LH concentration by gonadotropin-releasing hormone (GnRH) analog impairs follicular response to follicle stimulating hormone (FSH) and treatment outcome in in vitro fertilization (IVF) cycles.

For this purpose we retrospectively studied 249 consecutive women subjected to standard IVF treatment employing pituitary desensitization with buserelin and follicular stimulation with urinary highly purified FSH. The patients were divided into two groups according to their day 3 LH value. The first group (group A) showed day 3 LH levels < 3 IU/l and the second (group B) had day 3 LH levels > 3 IU/l. Group A and B patients did not show statistically significant differences in the ovarian response to FSH, nor in IVF treatment outcome, showing that in FSH treated GnRH analog suppressed cycles, the ovarian responsiveness and IVF outcome do not differ according to basal LH values. However, the high dosage of FSH we employed in group A and B patients could account, at least in part, for this result. Indeed, comparative evaluations with unsuppressed cycles (our previous study) strongly suggest that a reduced ovarian responsiveness to gonadotropins in patients with day 3 LH values < 3 IU/l should be considered in clinical practice.     

卵巢正常反应不孕症患者体外受精不同长方案促排卵效果的研究

目的探讨卵巢正常反应不孕症患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)促排卵时应用口服避孕药(OC)长方案和黄体中期长方案的促排卵效果及临床结局。方法选择接受长方案IVF/ICSI助孕的卵巢正常反应患者共4 677个周期;根据年龄分为≤35岁组和35岁组,不方便超声监测排卵或自然周期超声监测卵泡不破裂的患者共2 762个周期,应用OC长方案(OC组);自然周期超声监测正常排卵的患者共1 915个周期,应用黄体中期长方案(黄体中期组);常规行IVF/ICSI,比较上述不同年龄人群2种促排卵方案的临床和实验室相关指标。结果 (1)OC组促性腺激素(Gn)启动日雌二醇(E2)[≤35岁组:(24.63±10.62)ng/L,35岁组:(24.24±10.40)ng/L]和促黄体生成素(LH)水平[≤35岁组:(0.92±0.59)IU/L,35岁组:(0.82±0.66)IU/L]均明显低于黄体中期组[≤35岁组:(25.89±12.80)ng/L,35岁组:(25.71±10.93)ng/L;≤35岁组:(1.37±0.59)IU/L,35岁组:(1.01±0.70)IU/L](P0.05);(2)OC组人绒毛膜促性腺激素(h CG)注射日E2水平[≤35岁组:(4 143.8±2 769.9)ng/L,35岁组:(3 597.5±2 160.4)ng/L]和因卵巢过度刺激综合征(OHSS)行全胚冷冻率(≤35岁组:9.1%,35岁组:10.2%)均明显高于黄体中期组[≤35岁组:(3 850.8±2 092.4)ng/L,35岁组:(3 213.4±1 804.5)ng/L;≤35岁组:4.9%,35岁组:5.9%](P0.05),但h CG注射日的内膜厚度[≤35岁组:(10.75±2.25)mm,35岁组:(10.47±2.38)mm]却明显小于后者[≤35岁组:(11.62±2.43)mm,35岁组:(11.09±2.68)mm](P0.05);(3)在年龄35岁的OC组Gn总用量[(3 775.4±1 200.0)IU]和使用时间[(13.5±2.2)d]明显高于黄体中期组[(3 516.9±1 156.1)IU,(12.4±2.2)d](P0.05);(4)2种降调节方案患者的获卵数、ICSI成熟卵数、双原核(2PN)受精率、平均移植胚胎数、优质胚胎率和早期流产率均无明显差异(P0.05),但OC组的着床率(≤35岁组:41.4%,35岁组:25.5%)和临床妊娠率(≤35岁组:55.7%,35岁组:37.5%)明显小于黄体中期组(≤35岁组:46.7%,35岁组:31.4%;≤35岁组:65.6%,35岁组:46.9%)(P0.05)。结论 (1)OC长方案可加深垂体抑制,尤其是35岁的高龄患者需增加Gn用量才能达到与黄体中期长方案相似的促排卵效果;(2)OC长方案可能通过影响子宫内膜厚度及容受性而降低着床率和临床妊娠率;(3)OC长方案使h CG注射日E2水平更高,易诱发OHSS的发生。故对卵巢功能正常的不孕患者,IVF/ICSI助孕时尽量选择黄体中期长方案。     

微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用

目的:探讨微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用。方法:回顾性分析进行IVF/ICSI助孕的卵巢低反应患者共114个周期,根据用药情况分为3组:A组(来曲唑组,34个周期),B组(克罗米芬组,41个周期),C组(短方案组,39个周期)。比较3组患者的一般情况、Gn使用天数及总量、IVF相关指标及助孕结局。结果:①年龄、体质量指数(BMI)、不孕年限、基础内分泌水平组间比较均无统计学差异(P>0.05)。②A组Gn使用天数及总量、hCG注射日E2水平、优质胚胎率低于C组(P<0.05);hCG注射日LH水平、提前排卵率高于C组(P<0.05);平均获卵数、受精率、卵裂率、着床率、临床妊娠率A组与C组间比较均无统计学差异(P>0.05)。③B组Gn使用天数及总量、hCG注射日E2水平、平均获卵数、卵裂率均低于C组(P<0.05);hCG注射日LH水平高于C组(P<0.05);提前排卵率、受精率、优质胚胎率、着床率、临床妊娠率B组与C组间均无统计学差异(P>0.05)。④B组Gn使用天数及总量高于A组(P<0.05);其余相关指标组间比较均无统计学差异(P>0.05)。结论:微刺激方案可以获得与GnRH-a短方案相近的临床效果,同时降低Gn使用总量,减轻患者单周期治疗费用,是卵巢储备功能低下患者较理想的促排卵方案。     

Value of suppression with a gonadotropin-releasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization

This study examined the use of gonadotropin-releasing hormone agonist (GnRHa) suppression before gonadotropin stimulation in 26 patients with failed prior in vitro fertilization (IVF) attempts and variable basal serum gonadotropin levels. Leuprolide, 1 mg subcutaneously per day, was administered from the midluteal phase of the cycle before IVF treatment. Concomitantly, stimulation was initiated on cycle day 3 with human menopausal gonadotropin (hMG) and follicle stimulating hormone (FSH). Based on their prior IVF attempts and serum gonadotropin levels on cycle day 3, 9 patients were high responders with elevated mean basal luteinizing hormone (LH)/FSH, 8 were low responders with elevated mean basal FSH/LH, 7 were intermediate responders with normal mean basal FSH/LH and a history of premature LH surge, and 2 had elevated (perimenopausal) mean FSH and LH. Leuprolide was discontinued on the day of human chorionic gonadotropin (hCG) administration. Prior IVF attempts in the same patients with the same protocol, but without GnRHa suppression, were used as controls. The mean number of ampules of hMG and FSH was significantly higher in leuprolide cycles than in controls. The mean day of hCG administration was also higher for leuprolide cycles than for controls. The mean LH and progesterone levels on the day of hCG were significantly lower in leuprolide cycles. The mean number of preovulatory oocytes aspirated and transferred was higher in leuprolide cycles. Cancellation and pregnancy rates were improved in leuprolide cycles. It is concluded that prior GnRHa suppression is beneficial for follicular recruitment for IVF. More patients with variable basal serum gonadotropin levels need to be studied before definite recommendations are made.     

Hemodynamic changes induced by urinary human chorionic gonadotropin and recombinant luteinizing hormone used for inducing final follicular maturation and luteinization

OBJECTIVE: To compare the safety of recombinant human luteinizing hormone (LH) with that of urinary hCG in terms of the hemodynamic changes when they are used to induce final follicular maturation in patients undergoing in vitro fertilization (IVF). A secondary end point was efficacy in terms of IVF outcome. DESIGN: Prospective, randomized clinical trial. SETTING: University teaching hospital. PATIENT(S): Thirty IVF patients. INTERVENTION(S): Ovarian stimulation was induced with FSH under pituitary suppression. Patients were randomized to receive either hCG or recombinant human LH as a trigger of oocyte maturation (5,000 IU) and for luteal phase support (5,000 IU, 2,500 IU, and 2,500 IU on the day of follicular aspiration, 2 days later, and 5 days later, respectively). MAIN OUTCOME MEASURE(S): Mean arterial pressure, cardiac output, peripheral vascular resistance, and serum levels of progesterone, plasma concentrations of aldosterone, norepinephrine, and plasma renin activity were measured in all patients on postovulatory day 7 of the spontaneous menstrual cycle preceding IVF (baseline) and 7 days after the hCG/recombinant human LH ovulatory injection during the IVF cycle. RESULT(S): Ovarian response and IVF outcome (pregnancy rate, 60%) were similar in both treatment groups. On the seventh day after hCG/recombinant human LH administration, the peripheral vascular resistance was significantly lower and serum progesterone concentrations significantly higher in the hCG group as compared with the recombinant human LH group. The percentage change from baseline values during IVF cycles in all hemodynamic and neurohormonal variables investigated was higher (albeit not statistically different) in the group treated with hCG vs. the group treated with recombinant human LH. CONCLUSION(S): Recombinant human LH is associated with less intense circulatory changes than hCG when it is given to induce final follicular maturation and luteal phase support in IVF procedures.