最有效的治療卵巢過度刺激

Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study
Georg Griesinger, M.D., M.Sc., Ph.D. , Laura Schultz , Thomas Bauer, M.D. , Anke Broessner, M.D. , Thorsten Frambach, M.D. , Stefan Kissler, M.D., Ph.D.
Received 22 November 2010; received in revised form 25 January 2011; accepted 26 January 2011. published online 02 March 2011.
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Objective
To prospectively study ovarian hyperstimulation syndrome (OHSS) incidence and cumulative live birth rate in a cohort of patients at risk of OHSS undergoing ovarian stimulation in a GnRH antagonist protocol and receiving a GnRH agonist triggering followed by cryopreservation of all two pronuclei (2PN)-stage zygotes by two methods, vitrification or slow-cooling, for later ET.

Design
Prospective, clinical cohort study.

Setting
Five IVF centers in Germany; time frame: June 2008 to June 2010.

Patient(s)
Fifty-one female patients undergoing IVF considered at risk of developing severe OHSS (≥20 follicles ≥11 mm and/or E2level ≥4,000 pg/mL) after ovarian stimulation in a GnRH antagonist protocol.

Intervention(s)
Triptorelin (0.2 mg SC) for triggering final oocyte maturation. All 2PN-stage zygotes were cryopreserved by vitrification or slow-cooling for later repetitive frozen-thawed ET.

Main Outcome Measure(s)
Severe OHSS incidence and cumulative live birth rate per patient.

Result(s)
Of 51 patients, 1 patient (2%, 95% confidence [CI] 0.3%--10.3%) had zero oocyte retrieved, 1 patient did not undergo frozen-thawed ET, and 1 patient had no surviving oocyte after thawing. Thus, 48 patients underwent at least one frozen-thawed ET. The cumulative live birth rate was 37.3% (19/51, 95% CI 25.3%--51.0%). The live birth rate per first frozen-thawed ET was 5.9% (1/17, 95% CI 10.0%--27.0%) and 19.4% (6/31, 95% CI 9.2%--36.3%) in the slow-cooling and vitrification group, respectively (difference: 13.5%, 95% CI of the difference: -9.9%--31.1%). Three cases of OHSS II (3/51, 5.9%, 95% CI 2.0%--15.9%) and one early-onset case of OHSS III (1/51, 2%, 95% CI 0.3%--10.3%) occurred.

Conclusion(s)
Agonist triggering with cryopreservation is efficacious and safe, although a single

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• 最有效的治療卵巢過度刺激