打破卵針再打排卵針可增加試管嬰兒成功率

Follicle-stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in in vitro fertilization cycles: a randomized, double-blind, placebo-controlled trial
Presented as prize paper candidate oral presentation at the 67th Annual Meeting of the American Society of Reproductive Medicine, Denver, Colorado, October 25, 2010.

Julie D. Lamb, M.D. , Shehua Shen, M.D. , Charles McCulloch, Ph.D. , Liza Jalalian, B.S. , Marcelle I. Cedars, M.D. , Mitchell P. Rosen, M.D.
Received 24 August 2010; received in revised form 7 December 2010; accepted 6 January 2011. published online 11 February 2011.
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Article Outline
Abstract
Materials and methods
Patient Population and Randomization
Follicular Fluid
Outcomes
Statistical Analysis
Results
Discussion
Acknowledgments
References
Copyright
Objective
To determine whether an additional follicle-stimulating hormone (FSH) bolus administered at the time of the human chorionic gonadotropin (hCG) trigger can improve the developmental competence of the oocyte.

Design
Randomized, double-blind, placebo-controlled, clinical trial.

Setting
Academic medical center.

Patient(s)
Women undergoing a long agonist suppression in vitro fertilization (IVF) protocol for treatment of infertility.

Intervention(s)
FSH bolus at time of hCG trigger versus placebo.

Main Outcome Measure(s)
Primary outcome; fertilization; secondary outcomes: oocyte recovery, implantation rate, and clinical and ongoing pregnancy/live birth rates.

Result(s)
A total of 188 women (mean age: 36.2 years; range: 25 to 40 years) were randomized. Fertilization (2PN/#oocyte) was statistically significantly improved in the treatment arm (63% vs. 55%) as was the likelihood of oocyte recovery (70% vs. 57%). There was no statistically significant difference in clinical pregnancy rate (56.8% vs. 46.2%) or ongoing/live birth rate (51.6% vs. 43.0%).

Conclusion(s)
Improvements in IVF success rates have largely been due to optimization of embryo culture and stimulation protocols; less attention has been directed toward methods to improve induction of final oocyte maturation. This was the first randomized, double-blind, placebo-controlled trial to modify the ovulation trigger to improve oocyte competence, as demonstrated by the statistically significant improvement in fertilization.

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