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Comparison of Vaginal Gel and Intramuscular Progesterone for In vitro Fertilization and Embryo Transfer with gonadotropin-releasing hormone antagonist Protocol

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Chinese Medical Journal 2018年第13期131卷 1557-1561页

作者： Hong-Bin Chi Na-Na Liu Rong Li Li-Yuan Tao Li-Xue Chen Jie Qiao Center for Reproductive Medicine Peking University Third Hospital Beijing 100191 China Department of Obstetrics and Gynecology Peking University Third Hospital Beijing 100191 China Key Laboratory of Assisted Reproduction Ministry of Education Beijing 100191 China Research Center of Clinical Epidemiology Peking University Third Hospital Beijing 100191 China

Background： Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer （IVF-ET） with gonadotropin-releasing hormone （GnRH）-antagonist protocol. This study aimed to compare the effect between vaginal progesterone （VP） and intramuscular progesterone （IMP） with GnRH-antagonist protocol alter IVF-ET. Methods： A total of 1760 patients （18 years ≤ age ≤35 years） undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP （VP group） and 419 patients received IMP （IMP group） as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median （p25 and p75） and were compared using nonparametric Mann. Whitney U-test. Results： Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% （x^2 = 8.287, P= 0.004）. The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group （clinical intrauterine pregnancy rate 47.35% vs. 41.29%, x^2= 4.727, P = 0.030： implantation rate 30.99% vs. 25.26%, x^2=14.546, P 〈 0.001）. Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed. Conclusion： Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.

关键词： gonadotropin-releasing hormone antagonist Intramuscular Progesterone Undergoing In vitro Fertilization and EmbryoTransfer Vaginal Progesterone

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Effects of gonadotropin-releasing hormone antagonists on the expression of vascular endothelial growth factor and its receptors in a rat model of ovarian hyperstimulation syndrome

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Chinese Medical Journal 2008年第23期121卷 2434-2439页

作者： TONG Xiao-mei ZHANG Song-ying SONG Tao XU Wei-hai LIN Xiao-na SHU Jing LIU Liu Department of Reproductive Medicine Sir Run Run Shaw Hospital Affiliated with School of Medicine Zhejiang University Hangzhou Zhejiang 310016 China

Background Ovarian hyperstimulation syndrome （OHSS） is one of the most life-threatening complications of assisted reproduction treatments. gonadotropin-releasing hormone antagonists （GnRHanta） are thought to be effective in preventing this complication, and some clinical trials have found lower incidences of OHSS in patients treated with GnRHanta. Our aim was to investigate the effects of GnRHanta on vascular permeability and the expression of vascular endothelial growth factor （VEGF） and its receptors in a rat model of OHSS. Methods An immature early OHSS rat model was established. Three ovarian stimulation protocols were used： pregnant mare serum gonadotropin/human chorionic gonadotropin （hCG） alone, with a GnRHanta, or with a gonadotropin-releasing hormone agonists （GnRHa）. Blood and tissue samples were collected at 48 hours after hCG administration. Vascular permeability was evaluated by measuring the Evans-Blue content of extravasated peritoneal fluids. The expression of VEGF and its receptors, including fit-1 and KDR, were detected by reverse transcriptase-polymerase chain reaction and Western blotting. Results Treatment with both a GnRHanta and a GnRHa resulted in significant reductions in serum estradiol and peritoneal vascular permeability, as well as decreased ovarian expression of VEGF and its two receptors. However, GnRHanta treatment caused a greater reduction in serum estradiol concentrations, and in VEGF receptor mRNA expression than GnRHa. There were no significant reductions in the expression of VEGF or its receptors in extra-ovarian tissues, including the liver, lungs and peritoneum. Conclusion Our results reveal that GnRHanta are more potent than GnRHa in preventing early OHSS through down-regulation of the expression of VEGF and its receptors in hyperstimulated ovaries.

关键词： gonadotropin-releasing hormone antagonist gonadotropin-releasing hormone agonist ovarian hyperstimulation syndrome vascular endothelial growth factor

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Different Pretreatments before Application of GnRH antagonist Protocol in Controlled Ovarian Hyperstimulation

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Journal of Reproduction and Contraception 2011年第4期22卷 201-210页

作者： Ping-xiu HUANG Rong LI Min FU Juan-juan WANG Reproductive Medical Centre Shenzhen Hospital of Peking University Shenzhen 518036 China

Objective To analyze the clinical features and outcome of patients who used different pretreatments before application of gonadotropin-releasing hormone antagonist protocol during in vitro fertilization - embryo transfer （IVF-ET） cycles, and to explore how effective to use the antagonist protocol. Methods A retrospective analysis was performed. All the ET cycles were divided into three groups, group A （n=125） used short acting GnRH agonist before GnRH antagonist treatment, group B （n=113） used short-acting oral contraceptives before GnRH antagonist treatment, group C （n=81） was untreated before GnRH antagonist treatment. All the patients had no tubal fluid, endometrial polyps and no anatomical abnormalities of the uterus, from April 2010 to December 2010. The patient＇s age, dose and duration of gonadotropin （Gn） treatment, the serum LH and E2 levels on the day of hCG injection, the number of oocytes retrieved, the rates of good-quality embryos, the clinical pregnancy rates were compared. At the same time, 261 GnRH agonist long protocol cycles （group D） were selected at the same period as further comparison. Results The patients in group C （32.9 ~ 4.8 years） were significantly older than those in groups A and B （31.6 ___＋3.7 years, 31.2 ___%4.1 years）（P 〈0.05）. The dose and the duration of Gn in group C were significantly lower than those in groups A and B. The serum LH level on the day of hCG injection in group A and group B was significantly lower than that in group C （P 〈0.05）, especially in group A. The endometrium was the thinnest in group B. There were no significant differences in the fertilization rates and the good-quality embryosrates among them. The clinical pregnancy rate of group B decreased significantly compared with groups A and C （P〈0. 05）. The clinical pregnancy rate of group C was the highest among them. There was no significant difference of clinical pregnancy rates between group C and group D （37% vs 40.2%,P〉0.05）. However, the dose （19.8 ±6.6 am

关键词： in vitro fertilization-embryo transfer (IVF-ET) gonadotropin-releasing hormone antagonist short-acting oral contraceptives short-acting agonist

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