促性腺激素释放激素激动剂替代绒毛膜促性腺激素诱导排卵预防卵巢过度剌激综合征的初步观察

Preliminary observation of the effect of GnRH-a substituting for hCG to induce ovulation in preventing OHSS

目的 探讨采用促性腺激素释放激素激动剂 (GnRH a)替代人绒毛膜促性腺激素 (hCG)诱导排卵预防卵巢过度刺激综合征 (OHSS)的效果。 方法 在人绝经期促性腺激素 (HMG) /卵泡刺激素 (FSH)促排卵周期 ,当卵泡成熟后出现OHSS高危倾向时使用GnRH a鼻喷剂喷鼻 ,共 2d ,总剂量为 80 0～ 10 0 0 μg。用黄体酮 4 0mg/d肌注支持黄体功能 ,共15d。 结果 OHSS高危患者使用GnRH a诱导排卵 32例 ,其中排卵 2 8例、排卵率 88% ;妊娠 12例、妊娠率 38% ;流产 3例、流产率 2 5 % ;多胎妊娠 5例中双胎 3例、三胎 1例及五胎 1例 ,多胎妊娠率 16 % ;无一例重度OHSS发生。 结论 GnRH a替代hCG诱导排卵可以减少OHSS发生 ,且不降低妊娠率 ,但仍有较高的多胎妊娠率。

Objective: To evaluate the benefit of GnRH-a (buserelin) as the substitute for hCG to trigger ovulation in the prevention of ovarian hyperstimulation syndrome (OHSS). Method:Thirty-two women with polycystic ovary syndrome (PCOS), undergoing ovarian stimulation (HMG/FSH), were considered to be at risk of ovarian hyperstimulation (serum E_2 levels >7 320 pmol/L and >10 bigger follicles) and administered GnRH-a for 2 days. The total dose of GnRH-a was 800～1 000 μg. The progesterone was administered during the luteal phase (40 mg/day). Results: Among 32 cases. ovulation rate was 88% (28/32), pregnancy rate 38%(12/32), abortion rate 25%(3/12), multiple gestations rate 16% (5/32). Conclusion: GnRH-a substituting for hCG in the induction of ovulation may prevent OHSS in the patients with PCOS who are undergoing ovarian stimulation. However, the abortion rate and multiple gestations rate were still high.