The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） a...The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.展开更多
Background Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients＇ future fertility has been the focus of recent interest. ...Background Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients＇ future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists （GnRHa） cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients. Methods Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People＇s Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy （n=5） without GnRHa or were historical controls （n=11）. The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups. Results There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One （1/16） patient in the study group while 2 （2/16） patients in the control group relapsed 2 years after conclusion of the primary treatment （P 〉0.05）. All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment （P 〈0.05）. There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy. Conclusions GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.展开更多
To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of the...To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall GnRH a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laqaroscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases Results All cases remained amenorrheic during GnRH a therapy After the GnRH a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment In the 4 cases one pregnancy resulted in the birth of a healthy 3150?g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up Conclusions GnRH a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy For adenomyomata associated with infertility, GnRH a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs For infertility, GnRH a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases展开更多
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 ef...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.展开更多
文摘The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.
文摘Background Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients＇ future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists （GnRHa） cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients. Methods Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People＇s Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy （n=5） without GnRHa or were historical controls （n=11）. The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups. Results There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One （1/16） patient in the study group while 2 （2/16） patients in the control group relapsed 2 years after conclusion of the primary treatment （P 〉0.05）. All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment （P 〈0.05）. There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy. Conclusions GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.
文摘To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall GnRH a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laqaroscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases Results All cases remained amenorrheic during GnRH a therapy After the GnRH a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment In the 4 cases one pregnancy resulted in the birth of a healthy 3150?g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up Conclusions GnRH a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy For adenomyomata associated with infertility, GnRH a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs For infertility, GnRH a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases
文摘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.
