短效GnRH-a用于诱发排卵预防卵巢过度刺激综合征的临床效果

目的: 观察人绝经期促性腺激素(HMG)治疗周期中,对有可能发生卵巢过度刺激综合征(OHSS)者,使用短效促性腺激素释放激素类似物(GnRH-a)代替人绒毛膜促性腺激素(HCG)诱导排卵及预防OHSS 的效果。方法: 研究组65 例,均为用HMG 促排卵周期中出现卵巢过高反应者,卵泡成熟时使用曲普瑞林0.2mg 一次皮下注射,代替HCG 诱导排卵以预防OHSS 。排卵后肌注黄体酮40mg·d^-1支持黄体。对照组48 例,其中8 例出现卵巢过高反应中止治疗,40 例卵泡成熟时肌注HCG 5 000 ~10 000 IU 。结果: 注射曲普瑞林日血E2 水平平均3.8 ±0.9 ng·L^-1(2.9 ~ 5.8 ng·L^-1),直径≥11 mm之卵泡数平均25.4 ±8.3 个(18 ~ 35 个)。注射曲普瑞林后所有病例均有排卵,平均排卵数5.6 ±3.3 个(1 ~ 10 个),无一例出现重度OHSS 的症状及体征。18 例妊娠,妊娠率27.7 %(18 65),3 例自然流产。排卵率、妊娠率与对照组相同,无一例取消治疗周期。结论: 在未使用GnRH-a 行垂体降调节的超促排卵周期,单次足量使用短效GnRH-a 代替HCG 可有效诱导内源性LH、FSH 峰,促使卵母细胞最后成熟及排卵,同时可有效预防OHSS 的发生,对有OHSS 高危因素者,安全有效。

Clinical efficacy of short-effect GnRH-a for triggering ovulation on preventing ovarian hyperstimulation syndrome

AIM: To investigate the role of triggering ovulation and prevention of ovarian hyperstimulation syndrome (OHSS) by gonadotropin-releasing hormone agonist (GnRH-a) instead of human chorionic gonadotropin (HCG) in ovarian hyperresponders to human menopausal gonadotropin (HMG) treatment.METHODS: Research group involved 65 patients with high risk of developing OHSS, and they were given single dose subcutaneous injection of 0.2 mg triptorelin to trigger ovulation and prevent OHSS.Luteal support was initiated after ovulation with daily injections of 40 mg progesterone.There were 48 patients in control group, and 8 of them appeared ovarian hyperresponse to HMG and discontinued the treatment.40 patients were given HCG 5000 -10000 IU when follicles reached maturation.RESULTS: On the day of triptorelin injection the mean serum oestradiol concentration was 3.8 ±0.9 ng·L^-1 (range 2.9 -5.8 ng·L^-1)and the mean number of follicles ≥11 mm was 25.4 ±8.3 (range 18 -35).After triptorelin was administered,ovulation was effectively triggered in all of 65 patients, and the mean number of ovulation was 5.6 ±3.3 (range 1 -10).None of the patients developed signs or symptoms of severe OHSS.There were 18 (27.7 %) clinical pregnancies and 3 abortions.Ovulation rate and pregnancy rate showed no difference in comparison with control group, and none of research group discontinued the treatment.CONCLUSION: When the GnRH-a is not used before ovarian stimulation to pituitary down-regulation, adequate single dose of short-effect GnRH-a is able to effectively trigger an endogenous LH FSH surge, resulting in final oocyte maturation and ovulation, and furthermore it may effectively prevent OHSS.This strategy is special benefit to high responders with an increased risk of developing OHSS.