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Objective:To explore the factors affecting the pregnancy outcome of frozen-thawed embryo transfer (FET) in endometriosis (EMT) patients in order to provide reference for the clinical selection of FET strategies. Methods:A total of 329 EMT patients who received blastocyst FET at the Reproductive Medicine Center, Department of Obstetrics & Gynecology, The 900th Hospital of the Joint Logistics Support Force, PLA, from Jan. 2015 to Dec. 2017 were analyzed retrospectively. The patients were divided into three groups according to endometrial preparation protocols, ages, and endometrial thickness on the day of progesterone conversion, respectively. By endometrial preparation protocols, the three groups included gonadotropin-releasing hormone agonist (GnRH-a) down-regulation+ hormone replacement therapy (HRT) group (GnRH-a+HRT group, A1 group, n=138), HRT group (B1 group, n=52), and natural cycle (NC) group (C1 group, n=139). By ages, the three groups included 35 years old group (C2 group, n=59). By endometrial thickness on the day of progesterone conversion, the three groups included 12 mm group (C3 group, n=37). The differences in pregnancy outcomes among EMT patients with blastocyst FET were compared under different grouping factors. Results:The endometrium of A1 group was significantly thicker than that of B1 group (P=0.041), the implantation rate and clinical pregnancy rate of B1 group were significantly higher than those of C1 group (P=0.000, P=0.003). Compared with A1 group, the implantation rate of B1 group was significantly higher (P=0.023), while it was significantly lower in group C1 (P=0.027). The abortion rate of A2 group was significantly higher than that of B2 group (P=0.007). Compared with A3 group, the implantation rate of B3 group was significantly higher (P=0.041), while it was significantly lower in C3 group (P=0.026). Conclusion:HRT endometrial preparation protocol for EMT patients with blastocyst FET can improve the implantation rate and clinical pregnancy rate, and reduce the abortion rate and ectopic pregnancy rate, which may be an economical and efficient endometrial preparation protocol in clinical.
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Objective To observe the clinical efficacy of Dane Fukang Jiangao combined with gonadotropin-releasing hormone analogue(GnRH-a)in the treatment of endometriosis(EMT)after laparoscopic surgery. Methods A total of 120 EMT patients treated with GnRH-a after laparoscopic surgery were randomly divided into combine treatment group(n=60) and control group (n=60). In the control group, GnRH-a 3.75 mg was injected subcutaneously on the first day of menstruation and injected once every 28 days. The combine treatment group was given Dane Fukang Jiangao with oral administration 10 g per time, twice a day for 6 months. The changes of estradiol (E2), CA125 and visual analogue scale (VAS)were observed before and after treatment.Kupperman score was used to assess the degree of menopausal symptoms during treatment and follow-up records of recurrence. Results Before treatment, there were no significant differences in the serum levels of E2 and CA125 and VAS between both groups.After treatment,the serum levels of E2 and CA125 and VAS were significantly improved in both groups. And the serum level of E2 was significantly higher in combine treatment group than that of control group (P<0.05). The VAS and the serum level of CA125 were significantly lower than those of control group(P<0.05).Moreover,after treatment the Kuppermann score was significantly better in combine treatment group than that of control group (P<0.05). There was no significant difference in the recurrence rate in 6 months between the combine treatment group (21.7%) and the control group (38.3%, P>0.05). Conclusion Dane Fukang Jiangao in combination with GnRH-a can effectively prevent E2 from being too low,reduce the CA125 level after EMT surgery,relieve dysmenorrhea and menopausal symptoms,and prevent recurrence.
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Tradicionalmente, desde que se iniciaron las técnicas de reproducción asistida, se solía usar un bolo de 5 000-10 000 UI de gonadotropina coriónica humana para la maduración final de los ovocitos como método estándar. Recientemente, se ha introducido un nuevo concepto, en el que los agonistas de la hormona liberadora de gonadotropina juegan un papel esencial en este campo. Ofrece importantes ventajas, entre las que se incluyen: una virtual prevención completa del síndrome de hiperestimulación ovárica. No obstante, algunos estudios defienden que el uso de hormona liberadora de gonadotropina puede ocasionar un defecto en la fase lútea que puede finalizar en una disminución en las tasas de implantación, en las tasas de gestación clínica o en un aumento de las tasas de aborto precoz. Así pues, en esta revisión analizamos las diferentes opciones terapéuticas para desencadenar la maduración final de los ovocitos en las técnicas de reproducción asistida, y discutimos los riesgos, beneficios y posibles complicaciones del uso de los agonistas de la GnRH como inductor de ovulación en ciclos de fecundación in vitro/inyección intracitoplasmática de espermatozoides(AU)
Traditionally, a bolus of 5000-10000 IU human chorionic gonadotropin (hCG) was used for final follicular maturation and ovulation as a standard method since assisted reproduction techniques started (ART). Recently, a new concept in which the releasing gonadotropin hormone agonists (GnRH-a) play an essential role has been introduced. This offers important advantages, including virtually prevention of ovarian hyperstimulation syndrome (OHSS). However, some studies described that using GnRH-a, could lead to defects in the luteal-phase that may result in a reduction of the implantation and clinical pregnancy rates; and also in an increase of early abortion rates. Therefore, the aim of this review is the analysis of different pharmaceutical options to trigger final oocyte maturation in ART, and the discussion of the risks, benefits and likely complications associated with the use of GnRH-a as an inductor of the ovulation during in vitro fecundation/intracitoplasmatic sperm injection cycles (IVF/ICSI)(AU)
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Humans , Female , Pregnancy , Ovarian Hyperstimulation Syndrome/prevention & control , Chorionic Gonadotropin/therapeutic use , Reproductive Techniques, Assisted/standardsABSTRACT
Objective To investigate the hysteromyoma treated with the gonadotropin releasing hormone agonist(GnRH-a)and the impact on immunologic function.Methods 130 cases selected from the patients with hysteromyoma enrolled from January 2016 to December 2016 in hospital have been randomly divided into two groups.The control group has been treated with mifepristone while the study group GnRH-a.Results The sizes of uterus and myoma of both groups have no significant difference before treatment.After treatment, both of them are significantly improved, and those of the study group is significantly smaller than that of the control group(P<0.05).The levels of serum sex hormone and immunologic function of both groups have no significant difference before treatment.They are both improved after treatment, and the study group is significantly better than the control group(P<0.05).Conclusion Applying GnRH-a therapy to the patients with uterine myoma benefits for improving the therapeutic effect, which can improve the serum sex hormone levels and immunologic function.
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Objective To explore the impact of gonadotropin-releasing hormone agonist (GnRH-a) super-long protocol on embryo implantation rate and clinical pregnancy rate of in vitro fertilization and embryo transfer (IVF-ET) in patients with moderate-to-severe endometriosis. Methods This retrospective study included 120 women with endometriosis who received IVF-ET from Jun. 2012 to Jul. 2016 in Reproductive Medical Center of Changhai Hospital of Second Military Medical University. Among the 120 patients, 42 received super-long GnRH-a protocol, 38 received long GnRH-a protocol, and 40 received short GnRH-a protocol during IVF-ET. We compared: (1) The patients’ age, infertility years, basal serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), and the levels of FSH, LH, E2 and progesterone on the human chorionic gonadotropin hCG day; (2) the average number of retrieved oocyte, fertilization rate, cleavage rate, number of available embryos, embryo implantation rate and clinical pregnancy rate. Results (1) There was no significantdifference in general characteristics between three protocols. (2) Compared with the short GnRH-a protocol group, the super-long GnRH-a protocol and long GnRH-a protocol had significantly decrease serum LH and progesterone levelson the hCG day (all P<0. 05). (3) The fertilization rate, cleavage rate, embryo implantation rate and clinical pregnancy rate of super-long GnRH-a protocol were significantly higher than those of the short GnRH-a protocol (P<0. 05). Conclusion The IVF-ET using super-long GnRH-a protocol can improve the embryo implantation rate and clinical pregnancy rate of the patients withmoderate-to-severe endometriosis compared with using long or short GnRH-a protocol.
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[Objective]To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re-leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.[Methods]A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo-cyte numbers:group a1(15). The basic information of patients and clinical outcomes were compared.[Results](1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn-drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P<0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P<0.001).(2)When divided by ages,no mat-ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6%vs 39.8%,P=0.067;sub-group a2:9.7%vs 17.9%,P=0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8%vs 50.4%,P=0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6%vs 39.1%,P=0.021).(3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub-group b1(13.1%vs 26.0%,P=0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg-nancy rates were comparable in all sub-groups ,whereas differed considerably in sub-group b1 (36.6% vs 19.3%,P = 0.056).[Conclusion]Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH-ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders ,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.
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Objective:To study the clinical effect of letrozole combined with triptorelin acetate (GnRH-a) on the serum estrogen level and ovulation quality of patients with polycystic ovary syndrome(PCOS).Methods:112 cases of PCOS patients in our hospital from August 2014 to January 2016 were selected and randomly divided into the control group (50 cases) and the observation group (62 cases) according to the wishes of patients.During the first 3～7 days of the menstrual cycle,the patients in the observation group were treated by LE,2.5 mg/d;the patients in the control group were given intramuscular injection of human menopausal gonadotropin (HMG),75 IU/d.when the diameter of the largest follicle (MFD)≥ 18 mm,the patients in the observation group were were given subcutaneous injection of 0.1 mg triptorelin acetate induced ovulation,patients in the control group were given intramuscular injection of Human chorionic gonadotropin HCG6000～10000IU induced ovulation.The ovulation induced ovulation effect and the serum hormone levels and pregnancy outcome were compared between two groups.Results:On the induced ovulation day,no significant difference was found in the endometrial thickness,the number of mature follicles,serum LH and P levels,rate of pregnancy and the luteal function between two groups of patients (P＞0.05),the number of dominant follicles,serum E2 and T levels,multiple pregnancy rate,the incidence of OHSS and ovarian cyst in observed group were significantly lower than those of the control group (P＜0.05).Conclusion:LE combined with GnRH-a could effectively improve the quality of ovulation in patients with PCOS,reduce the serum level of estrogen,and prevent the occurrence of OHSS,improve the outcome of pregnancy.
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Objective Clinical efficacy was compared among single injections of different doses of long acting gonadotropin releasing hormone agonist (GnRH-a),and daily injections of short-acting GnRH-a in order to evaluate different methods of ovarian stimulation for in vitro fertilization (IVF) cycles.Methods A retrospective study of 214 patients who underwent IVF assisted fertility treatments was conducted.Patients were allocated into four study groups:the short protocol (group A),in which daily injections of 0.1 mg GnRH-a was administered in the mid-luteal phase until the day of human chorionic gonadotropin (hCG) administration (see below);or the long protocol (group B,C & D),in which single injections of 3.75mg,2.0mg,or 0.9mg of long-acting GnRH-a was given in the mid-luteal phase,respectively.Stimulation with gonadotropins (Gn) started when pituitary down-regulation was established.When vaginal ultrasonographic scans showed that at least two follicles had reached 16-20mm in diameter,Gn stimulation was withdrawn,and serum estradiol (E2),progesterone (P),and luteinizing hormone (LH) were determined.Additionally,human chorionic gonadotropin (hCG) was administered that evening.Egg collection was performed 38 hours after hCG injection and the standard IVF procedure was performed.Results There were no statistically significant differences amongst the four groups when measuring serum LH levels,number of oocytes,number of fertilized eggs,number of good quality embryos,and clinical pregnancy rate.The total amount of Gn administered was almost identical when comparing group A and group D,as well as when comparing group B and group C.However,Group A and D required less Gn stimulation to exhibit follicles of 16-20mm in diameter,compared to group B and C (P ＜0.005).Moreover,there was a significant difference in the time required for ovulation induction between group A and group C,where group A had a shorter time to ovulation.The fertilization rate was statistically different between group B and other groups (P ＜ 0.005).Conclusion Through our data analysis,we conclude based on outcome,cost,side-effects,and simplification of treatments,that the 0.9mg long-acting GnRH-a treatment is eminent for ovarian stimulation for IVF.
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0bjective To compare the curative effects of GnRH-a and mifepristone in treatment of endometriosis after laparoscopic operation.Methods 114 cases of patients were selected from March 2012 to December 2014 in our hospital with endometriosis after laparoscopic surgery,randomly divided into mifepristone group,GnRH-a group and untreated group,each group for 38 cases.mifepristone group were treated by oral mifepristone one week after operation,25 mg,qd,continuing to take 6 months;GnRH-a group,post operative 1 week received injection of GnRH-a (Tamiflu)3.75 mg,once every 4 weeks,6 times in a row;The untreated group,fails to drug treatment.To compare the symptoms,relapse rate pregnancy rate and serum hormones including FSH, LH and E2 levels.Results After treatment, the total effective rate of GnRH-a and mifepristone group is significantly higher than the untreated group(P<0.05),and the recurrence rate is lower than the untreated group(P <0.05),the pregnancy rate is higher than the untreated groups(P<0.05).The recurrence rate,the remission rate and the pregnancy rate of mifepristone group are lower than the untreated group,there was no statistical significance.Conclusion Mifepristone and GnRH-a can both,effectively reduce the recurrence rate after EMT laparoscopic surgery,can guarantee the pregnancy rate,reduce the adverse reaction.
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Objective To discuss the clinical impact of laparoscopic surgery combined with GnRH-a for endometriosis infertility. Methods From June 2013 to June 2014, 88 endometriosis infertility patients were selected and divided into study group and the control group by the random number table method. The patients in study group were treated with laparoscopic surgery combined with GnRH-a. The patients in control group were treated with only laparoscopic surgery. The clinical efficacy, ovarian function and pregnancy outcomes of the patients in two groups were compared and analyzed. Results Compared with control group, the patients in study group, the clinical treatment for endometriosis achieved complete remission rate was 65.91 % (29/44) and total effective rate was 93.18 % (41/44), there were increased significantly, and the recurrence rate was 2.27 % (1/44), there was decreased significantly, after statistical analysis, the differences were significant statistically (P < 0.05). Compared with control group, the patients in study group after treatment, the level of E2 was (80.96 ± 17.65) ng/L, there were increased significantly, while the level of LH was (10.94 ± 3.20) IU/L and FSH was (6.24 ± 1.38) IU/L, there were decreased significantly, after statistical analysis, the differences were significant statistically (P < 0.05). Compared with control group, the patients in study group, the pregnancy rate was 47.73 % (21/44) and the living rate was 45.45 % (20/44), there were increased significantly, while the not pregnancy rate was 52.27 % (23/44), there was decreased significantly, after statistical analysis, the differences were significant statistically (P < 0.05). Conclusions Laparoscopic surgery combined with GnRH-a could improve the clinical efficacy of endometriosis infertility patients effectively, and further improve the ovarian function of patients, improve the pregnancy rate significantly.
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Objective Based on the immunologic balance, to investigate the mechanisms of Danchi decoction for controlling the recurrence of endometriosis (EMs) of qi stagnation and blood stasis after conservative operation. Methods A multi-center and randomized clinical trial was adopted. EMs patients were divided into Chinese medicine group (CG, 20 cases) and western medicine group (WG, 10 cases). The two groups were given Danchi decoction and GnRH-a or gestrinone respectively for 3 months. The serum IL-2, IL-6 and IL-2/IL-6 were detected before operation, after 3 months of treatment and 3 months after withdrawal, and compared with the control group (5 cases of simple ovarian cysts). Results Before operation, the serum IL-2 level of CG and WG was lower than control group (P0.05), but 3 months after withdrawal, IL-2/IL-6 of WG was significantly lower than that of control group (P<0.05). Conclusion Immune imbalance is closely related to the occurrence and development of EMs. Danchi Decoction or GnRH-a or gestrinone can prevent the recurrence of EMs by adjusting the disorder of immune response, and Danchi Decoction has better effect on long-term result.
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Objective To investigate the role of survivin gene in the pathogenesis of endometriosis (EMs). Methods The expressions of survivin in endometriosis and normal endometrium tissue were determined ; the effects of GnRHa and COX-2 on the expression of survivin mRNA in endometriosis and normal endometrium in vitro and the effects of GnRHa and COX-2 on the apoptosis index in the cultured ectopie endometrial cells were investigated. Re-sults ①The expression of survivin mRNA was higher in patients with endometriosis than that of healthy controls (P <0.01) ,with no cyclical variation. ②GnBHa exerted a dose-dependent suppression of survivin mRNA expres-sion in cultured ectopic endometrioma cells as well as COX-2. The significant suppression was observed at the 100μg/L concentration of GnRHa and at the 40 μmol/L concentration of COX-2. No cooperation was found between them (P > 0.05). Conclusion ①The up-regulation of survivin mRNA expression may reduce the sensitivity of en-dometriotic cells to apeptosis. Elevated expression of survivin mRNA in ectopic endometrium may have important im-plications for the survival and proliferation of the ectopic endometrial tissue.②Both GnRHa and COX-2 can promote apoptosis by inhibiting survivin mRNA expression in ectopic endometrioma cells in vitro.
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Objective To study the effect of GnRH on the secretion of 5-HT in the stomach. Methods The GnRH-A Alarelin was directly injected into the stomach of rats to observe the change of density of 5-HT immunoreactive positive cell in the stomach and small intestine by immunohistochemical SABC method and 5-HT level in the circulating blood by HPLC-ECD, Results Compared with the control group,which was injected with saline into the stomach,the density of immunoreactive positive cell was significantly increased in the stomach and small intestine in the GnRH-A treatment group;while 5-HT level in the circulating blood was significantly reduced in the experimental group.Conclusion GnRH can inhibit the releasing of 5-HT but not change its synthesis.
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OBJECTIVES: The microdose of gonadotrophin-releasing hormone agonist (GnRHa) has been suggested as a beneficial method of ovulation induction for poor responders. However, the effect of microdose of GnRHa itself has not been evaluated yet. We performed a prospective sutdy to assess the effect of microdose of GnRHa (5 microgram of triptorelin acetate) on the luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary objective of this study is to assess how long the down-regulation of gonadotrophin secretion by microdose GnRHa persists. METHODS: Five microgram of triptorelin was injected daily into five normally menstruating women for 7 days starting from cycle day 3. The blood sample was drawn for 12h with 4h interval, then for 6days with 4 h interval and once a day for 14days, In next cycle, same amount of triptorelin was injected into the same subjects daily for 3 days. The blood sample was drawn twice a day for 20days. Serum FSH, LH and extradiol level was measured. RESULTS: The serum LH and FSH level increased rapidly after injection of first GnRHa. The FSH level reached peak (27.53+/-6.34 IU/l) in 5h while LH level reached peak (34.35+/-7.18 IU/l) in 4h. The flare of gonadotrophins persisted even after second and third day injection of GnRHa, although the peak levels were not as high as first injection. The down regulation of gonadotrophin was established in 4-5 days. The estradiol level increased for 4-5 days then decreased. When GnRHa was given for 7days, the estradiol level began to rise 7-8 days after last injection; when given for 3days, the estradiol level began to rise 3-6 days after last injection. CONCLUSION: Even with ultra-low dose of GnRHa, the down-regulation of gonadotrophin could be achieved. The flare-up of gonadotrophin would persist for 3days with this dose. The duration of down regulation was influenced by the duration of GnRHa administration.
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Female , Humans , Down-Regulation , Estradiol , Follicle Stimulating Hormone , Gonadotropin-Releasing Hormone , Gonadotropins , Luteinizing Hormone , Ovulation Induction , Prospective Studies , Triptorelin PamoateABSTRACT
OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.
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Humans , Clomiphene , Embryonic Structures , Estrogens , Gonadotropin-Releasing Hormone , Pregnancy Rate , Progesterone , SuperovulationABSTRACT
Objective To investigate the effect of GnRH-A in gastric cavity on the function of somatostatin cells in the digestive tract of rats. Methods The immunohistochemical ABC method and enzyme-link immunoassay were used in the experiment. Results The densities of the somatostatin positive cells in the stomach and duodenum of the experiment groups were 26
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Objective To investigate the effect of GnRH-A in gastric cavity on function of gastrin clls in digestive tract of rats. Methods The immunohistochemical ABC method and enzyme-link immunoassay were used in the experiment. Results The densities of the gastrin immunoreactivity cells in the stomach and small instestin of the experiment groups were 19.60?3.63 and 18.00?2.31 respectively, those in stomach was 10.30?2.41 while in small intestin was 9.00?2.05 of control groups respectively (P