科研之友
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摘要
Objective: To investigate whether delaying the start of ovarian stimulation with GnRH antagonist improves ovarian response in poor responders. Design: Retrospective study. Setting: Academic medical center. Patient(s): Thirty patients, who responded poorly and did not get pregnant with conventional estrogen priming antagonist IVF protocol. Intervention(s): Delayed-start antagonist protocol (estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation). Main Outcome Measure(s): Number of dominant follicles and mature oocytes retrieved, mature oocyte yield, and fertilization rate. Result(s): The number of patients who met the criteria to proceed to oocyte retrieval was significantly higher in the delayed-start protocol [21/30 (70%)] compared with the previous conventional estrogen priming antagonist cycle [11/30 (36.7%)]. The number of dominant follicles was significantly higher in the delayed-start (4.2 +/- 2.7) compared with conventional (2.4 +/- 1.3) protocol. In patients who had oocyte retrieval after both protocols (n = 9), the delayed start resulted in shorter ovarian stimulation (9.4 +/- 1.4 days vs. 11.1 +/- 2.0 days), higher number of mature oocytes retrieved (4.9 +/- 2.0 vs. 2.2 +/- 1.1), and a trend toward increased fertilization rates with intracytoplasmic sperm injection (ICSI; 86 +/- 17% vs. 69 +/- 21%) compared with conventional protocol. After delayed start, the average number of embryos transferred was 2.8 +/- 1.4 with implantation rate of 9.8% and clinical pregnancy rate of 23.8%. Conclusion(s): The delayed-start protocol improves ovarian response in poor responders by promoting and synchronizing follicle development without impairing oocyte developmental competence.
- 出版日期2014-5
