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Androgen deprivation therapy (ADT) using gonadotropin?releasing hormone agonist (s) (GnRH?A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH?A. All GnRH?A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (?50 ng/dL in a month and ?20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ?50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate?specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10?year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10?year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10?year survival rate of 87%, and triptorelin had an 8?year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH?A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH?A. Goserelin appears to be the most convenient of all the GnRH?A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH?A for ADT in prostate cancer.
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ABSTRACT Objective: To investigate the effects of buserelin on the development of follicles, apoptosis index and steroid hormones level. Methods: Twenty-four 3-month-old female rats were randomly divided into three groups: a low-dose group, a high-dose group and a control group (n = 8). Buserelin and normal saline were injected subcutaneously for 5 days. Thirty days after the first injection, the ovaries were removed for staining. Blood samples were collected and centrifuged. Their serum was used for measuring estradiol and progesterone levels, using enzyme-linked immunosorbent assay. Results: The findings revealed a significant decrease in the mean of secondary and Graafian follicles in the high-dose group compared with the control group (p = 0.037, p = 0.034, respectively). The serum estradiol level increased significantly in the high-dose group, compared with the low-dose and control groups (p = 0.027, p = 0.047, respectively). The serum progesterone level decreased, although not significantly. In contrast to the control group, the significant increase of apoptotic cell death was found in primordial, unilaminar and multi-laminar follicles in the high-dose group (p = 0.004, p = 0.049, p = 0.047, respectively). Conclusion: The findings of this study suggest that short-term administration of high-dose buserelin increases the serum estradiol level and apoptosis in the granulosa cells but has an inhibitory effect on follicular development.
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@#【Objective】To investigate the effect of adding different preparations containing luteinizing hormone activity in patients with normal ovarian reserve but suboptimal response during GnRH agonist protocol when undergoing IVF/ICSI- ET.【Methods】872 infertile patients with normal ovarian reserve but suboptimal response to FSH during GnRH agonist protocol were enrolled. According to the supplementation of different preparations containing LH activity ，patients were divided into three groups，including low- dose hCG group（n=28），rLH group（n=319）and HMG group（n=525）. The clinical parameters and pregnancy outcomes were retrospectively compared among three groups.【Results】The proportion of ultra-long GnRH-a protocol in hCG group was higher than that in HMG group（14.3% vs. 1.1%，P＜0.001）. The total duration and dosage gonadotrophin in hCG group were more than that in HMG group ［15.0（13.0~16.8）vs. 13.0（12.0~15.0）days ，P = 0.027 ；2 925（2 531~3 900）vs. 2 550（2 100~3 225）U ，P = 0.046］. The total duration and dosage gonadotrophin in rLH group were less than that in HMG group［13.0（12.0~14.0）vs. 13.0（12.0~15.0）days，P = 0.009；2 400（1 950~3 075）vs. 2 550（2 100~3 225）U ，P = 0.009］. There were 53.6%（15/28）patients who still showed suboptimal response after the administration of HMG or rLH in hCG group. The clinical pregnancy rate（69.2%，58.6% vs.63.8%；P＞0.05）and live birth rate（65.4%，49.6% vs. 53.1%；P＞0.05）were similar among these groups.【Conclusions】 For patients with normal ovarian reserve but suboptimal response during GnRH agonist protocol ，the supplementation of different preparations containing LH activity showed comparable effect on pregnancy outcomes. The addition of low- dose hCG was effective even when patients still showed suboptimal response after the administration of HMG or rLH.
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Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation.Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos.Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05).Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.
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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 investigate the effects of three kinds of endometrial preparation (normal hormone replacement, half- and full-dose of long-acting gonadotropin-releasing hormone agonist (GnRH-a) down-regulation combined with hormone replacement) on the pregnancy outcomes in the frozen-thawed embryo transfer (FET) cycle in the patients with endometriosis (E M T), adenomyosis or repeated implantation failure (RIF) for unknown reasons, and to provide a basis for the selection of clinical endometrial preparation method. Methods: A total of 191 patients with EMT, adenomyosis or RIF for unknown reasons underwent FET treatment were selected. The patients were divided into normal hormone replacement group (n=63), half-dose GnRH-a group (n=61) and full-dose GnRH-a group (n=67) according to the endometrial preparation method. The clinical data of patients in each group such as age, body mass index (BMI), duration of infertility, the number of embryo transfer cycles, the number of embryos transferred, the endometrial thickness on the day of conversion and transplantation, the rate of high-quality embryos transferred, the intrauterine clinical pregnancy rate and the embryo implantation rate were analyzed retrospectively and compared. Results: There were no significant differences of the general clinical data of the patients in FET cycles in three groups such as age, BMI, duration of infertility, the number of embryo transfer cycles, the number of embryos transferred, the endometrial thickness on the day of conversion and transplantation, and the rate of high-quality embryos transferred (P
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OBJECTIVE: To evaluate the effect of Kuntai capsule on the gonadotrophin releasing hormone agonist(GnRH-a)-induced perimenopaus symptoms and the sex hormone levels.METHODS: A total of 99 patients with uterine fibroids,adenomyosis or moderate to severe endometriosis who needed the treatment of GnRH-a at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2015 to March 2016 were collected and randomly divided into research group(Kuntai capsule)and control group(Tibolone). GnRH-a was injected once every 28 days and first injection of GnRH-a was administered on the 2 nd to 4 th day of menstrual period or retraction bleeding after surgery.Kuntai capsule or Tibolone was orally taken beginning from the first GnRH-a injection,and the co-administration of Caltrate D-600 and alfacalcidol was given in both groups.The Kupperman scores,sex hormone levels including folliclestimulating hormone(FSH)and estrogen(E_2),and adverse events were recorded.RESULTS: Kuntai capsule kept the perimenopause symptoms at mild level with the slow increase of Kupperman scores,whose effect was significantly superior to Tibolone(P<0.05)after 8 weeks of treatment,especially in paresthesia,nervousness,and formication.The FSH and E_2 levels in both Kuntai and Tibolone groups were obviously decreased when compared with the pre-treatment(P<0.05),and these hormone levels in Kuntai group were comparable to those in Tibolone group.No adverse events occurred in either group. CONCLUSION: In the short-term treatment of GnRH-a,Kuntai capsule exhibits significant alleviating effects on perimenopause symptoms caused by GnRH-a with high safety and few adverse reactions.
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Objective To evaluate systematically the effectiveness of gonadotropin-releasing hormone agonist (GnRHa) administration before chemotherapy and/or during chemotherapy for the protection of ovarian function in premenopausal women. Methods PubMed, Cochrane Library, Medline, Embase, China Biomedical Literature Database, CNKI were searched to collect the clinical randomized control trail (RCT) of ovarian function protection in premenopausal women receiving chemotherapy by using GnRHa. RevMan5.3 software was used to analyze the incidence of early premature ovarian insufficiency (POI), menstrual recovery rate, pregnancy rate and other indicators. Results A total of 12 articles were included, including a total of 1509 premenopausal women who received chemotherapy for malignant diseases. GnRHa combined with chemotherapy reduced the incidence of POI (OR = 0.36, 95％ CI 0.23-0.56, P < 0.01) and improved the menstrual recovery rate during follow-up (OR = 2.49, 95％ CI 1.72-3.60, P < 0.01). GnRHa combined with chemotherapy could increase the pregnancy rate of patients aged 35 years and older (OR = 2.04, 95％ CI 1.08-3.83, P = 0.03). Conclusion GnRHa administration before chemotherapy and/or during chemotherapy may prevent the chemotherapy damage to ovarian function, reduce the incidence of POI, and improve the recovery rate of menstruation.
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Objective To explore the significance of the cut point of peak level of luteinizing hormone (LH) in gonadotropin-releasing hormone (GnRH) agonist test in the diagnosis of precocious puberty in obese girls.Methods According to the diagnostic criteria of children's central precocious puberty diagnosis consensus (2015),796 cases of precocious puberty (peak level of LH ≥3.3 IU/L) in Children's Hospital of Zhejiang University School of Medicine from January 2014 to December 2015 were divided into normal weight group (573 cases),overweight group (170 cases) and obesity group (53 cases).The 3 groups were compared in terms of basic level of LH,basic level of follicle stimulating hormone (FSH),peak level of LH and FSH,ratio of LH (peak)/FSH (peak),sex hormone binding protein (SHBG),and children with 3.3 IU/L ≤peak level of LH ＜5.0 IU/L were followed up.The accuracy of the diagnosis of central precocious puberty using peak level of LH was analyzed by using receiver operating characteristic (ROC) curve.Results The median of LH (peak) in the obese group was 6.92 IU/L,the median of SHBG was 46.52 nmol/L,the median of LH (peak) in normal weight group was 8.92 IU/L,and the median of SHBG was 87.28 nmol/L.There were significant differences between the 2 groups (P ＜ 0.05,0.001).A total of 89 cases in normal weight group and 65 cases of obesity/overweight group (3.3 IU/L ≤peak level of LH ＜5.0 IU/L) were followed up for 1 year,and 18 cases in normal weight group and 33 cases in obesity/overweight group developed to central precocious puberty,while the number of cases in the 2 groups was significantly different (P ＜0.001).The ROC curve analysis showed that the cut point of peak level of LH was 4.16 IU/L,the sensitivity was 0.606,the specificity was 0.656,and the Jordan index was the largest (0.344).Conclusions The peak level of LH in GnRH agonist test is important for the diagnosis of central precocious puberty in girls,but the effect of body mass index on its cut point needs to be considered.
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OBJECTIVE: To describe the clinical outcomes of frozen-thawed embryo transfer (FET) with artificial preparation of the endometrium, using a combination of estrogen (E2) and progesterone (P4) with or without a gonadotropin-releasing hormone agonist (GnRHa), and the modified natural cycle (MNC) with human chorionic gonadotropin (hCG) trigger. METHODS: In this retrospective study, we evaluated 187 patients during 3 years (February 2012–April 2015). The patients were allocated to the following treatment groups: group A, comprising 113 patients (181 cycles) who received GnRHa+E2+P4; group B, comprising 49 patients (88 cycles) who received E2+P4; and group C, comprising 25 patients (42 cycles) who received hCG+P4. The inclusion criteria were regular menstrual cycles (length 24–35 days) and age 21–45 years. RESULTS: The primary outcome of the study — implantation rate (IR) per embryo transferred — was not statistically different among the 3 groups. Similar results were found for the IRs with fetal heartbeat per embryo transferred (68/181 [37.6%] in group A vs. 22/88 [25.0%] in group B vs. 14/42 [33.3%] in group C) and for the live birth rates (LBRs) per embryo transferred (56/181 [30.9%] in group A vs. 18/88 [20.5%] in group B vs. 11/42 [26.2%] in group C). CONCLUSION: Although the pregnancy outcomes were better in the hormone therapy with GnRHa group, hormone therapy FET with GnRHa for pituitary suppression did not result in significantly improved IRs and LBRs when compared with hormone therapy FET without GnRHa or MNC FET.
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Femenino , Humanos , Embarazo , Gonadotropina Coriónica , Transferencia de Embrión , Estructuras Embrionarias , Endometrio , Estrógenos , Hormona Liberadora de Gonadotropina , Infertilidad , Nacimiento Vivo , Ciclo Menstrual , Resultado del Embarazo , Progesterona , Estudios RetrospectivosRESUMEN
Objective To explore the clinical effects of magnetic resonance guided high intensity focused ultrasound ( MRgHIFU ) and gonadotropin releasing hormone agonist ( GnRH-a ) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent uterine fibroids. Methods Eighty patients of recurrent uterine fibroids from April 2015 to June2017 in the First Hospital of Harbin were collected and randomly divided into the observation group and control group. MRgHIFU was used in the observation group were employed,and patients in the control group were treated with ING-IUS after first injecting GnRH-a. The tumor volume,hemoglobin level,menstrual quantity and adverse reactions were compared before and at 3 months,6 months after treatment. Results After 6 months,the size of the uterine myoma in the observation group was ((80. 23 ± 4. 35) cm3 ),significantly lower than that of the control group (( 135. 46 ±9. 25) cm3 ),and the difference was statistically significant ( t = 6. 01,P < 0. 05) . At 3 and 6 months after treatment,the amount of menstruation in the observation group was significantly lower than that of the control group( (66. 37 ± 12. 12) points vs. (40. 46 ± 10. 15) points; (98. 42 ± 14. 12) points vs. ( 68. 26 ± 11. 38) points). The difference was statistically significant (t at 3 months after treatment= 4. 52,P<0. 05,t at 6 months after treatment= 3. 53,P<0. 05). After 6 months of treatment,the hemoglobin value of the observation group was significantly higher than that of the control group (( 142. 12 ± 4. 24) g/ L vs. ( 108. 27 ± 3. 09) g/ L), the difference was statistically significant (t= 5. 02,P<0. 05),while the adverse reactions such as vaginal bleeding, hot flashes and night sweats were lower than those of the control group (2. 5% (1/ 40) vs. 7. 5% (3/ 40)) (χ2= 3. 99,P<0. 05). Conclusion Magnetic resonance guided high intensity focused ultrasound was considered as safe and effective in treating uterine fibroids,which is a new and noninvasive therapeutic methed,
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[Objective] To investigate the effects of different doses of gonadotropin releasing hormone agonist (GnRH-α) on the down-regulation of normal ovarian reserve,and compared the down-regulation level as well as the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET) cycles.[Methods] This RCT study included 63 infertility couples of age＜35 yrs.women with normal ovarian reserve function who were intended to received GnRH-α long protocol treatment.Of the 63 women were randomly divided into three groups according to the dose of triptorelin,21 received daily 0.05 mg short-acting GnRH-α,21 received daily 0.1 mg short-acting GnRH-α,while 21 received reduced-dose depot of 1.25 mg GnRH-αt.[Results] In the three groups,the average duration of down-regulation reached after injection of GnRH-α,the level of LH and E2,the total number of antral follicles,the number of antral follicles of ＜4 mm and 8～9 mm were similar.The serum follicle-stimulating hormone level on the day of gonadotropin initiation were significantly higher in the two short-acting groups compared with the long-acting group [(3.92 ± 1.12) U vs.(3.03 ± 1.14) U vs.(2.05 ± 1.12) U,P＜ 0.001].Four hours after the GnRHa injection,the serum FSH,LH levels were higher in short-acting 0.05 mg group than the short-acting short-acting 0.1 mg group.Both number of days of gonadotropin stimulation and gonadotropin doses were similar in three groups.On the day of hCG administration,the numbers of 14-18mm diameter follicles [(3.91 ±2.12) vs.(5.81 ±3.55) vs.(6.43±3.39),P＜0.001] as well as the proportion of follicles with diameter ≥18 mm/≥10 mm [(33.1％± 13.2％) vs.(24.0％±12.4％) vs.(30.1％±12.2％),P＜0.05],were both statistically significant different in three groups.Although serum LH level on hCG day was significantly increased in 0.05 mg group [(2.47±1.33) U vs.(1.80±0.69) U vs.(1.43±0.53) U,P＜0.05].No premature LH surge and premature ovulation was observed.The number of retrieved oocyteswas significant different [(10.14±4.80) vs.(11.51±2.42) vs.(12.79±2.73),P＜0.05].However,no significant differences was found regard to the number of MII oocytes,and the serum estrogen level per egg was significant higher in 0.05 mg group [(282.33±42.13) U vs.(221.62±32.02) U vs.(200.03±37.89) U,P＜0.001].The live birth rate (LBR) of these three groups in fresh cycles were 61.9％,55.0％,and 50.0％,respectively.The cumulative LBR were 85.7％,76.2％,and 75.0％,respectively.A increased trend was observed in the clinical pregnancy rate,cumulative clinical pregnancy rate and cumulative LBR in 0.05 mg group than the other two groups.[Conclusion] For women with normal ovarian reserve,as the GnRH-α dosage decreased,the down-regulation of pituitary reduced,while serum LH levels on the day of hCG trigger increased.The number of oocytes retrieved was decreased,the proportion of cycles which retrieved ＞ 15 oocytes was also lower.However,the average estrogen level per egg was significant increased,and a better clinical outcome of IVF-ET was received.
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The clinical outcomes of five groups of infertility patients receiving frozenthawed,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 cotreatment 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.
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The clinical outcomes of five groups of infertility patients receiving frozenthawed,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 cotreatment 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.
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PURPOSE: The effects of gonadotropin-releasing hormone agonist (GnRHa) treatment on body mass index (BMI) are controversial in girls with central precocious puberty (CPP). We therefore evaluated auxological parameters during GnRHa therapy in patients with CPP, specifically focusing on changes in BMI. METHODS: Seventy-seven girls with idiopathic CPP who underwent GnRHa therapy were retrospectively recruited. We investigated BMI changes during the treatment period after stratifying them according to baseline BMI status as follows: normal (BMI percentile of <85th) and overweight groups (BMI percentile of ≥85th). RESULTS: The incidence of overweight/obesity (40.3%/23.4%) was very high in the girls with CPP. In the overall study population, no significant BMI change was observed during the GnRHa treatment period. However, when stratified according to baseline BMI status, the normal-weight group showed a significant increase in BMI-standard deviation score (SDS), whereas the overweight group showed no change in BMI-SDS. Baseline BMI-SDS was an independent predictor of changes in BMI during the GnRHa treatment period. Changes in weight-SDS were similar, but changes in height-SDS were significantly greater in the overweight group than in the normal-weight group, which explains the observed difference in BMI-SDS. CONCLUSION: Our results demonstrate that the difference in the pattern of BMI changes among our CPP patients suggests that delayed puberty induced by GnRHa treatment may have different effects on linear growth according to baseline body composition. This study underscores the importance of individualized lifestyle intervention in CPP children.
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Niño , Femenino , Humanos , Composición Corporal , Índice de Masa Corporal , Hormona Liberadora de Gonadotropina , Incidencia , Estilo de Vida , Obesidad , Sobrepeso , Pubertad Tardía , Pubertad Precoz , Estudios RetrospectivosRESUMEN
Objective To evaluate the curative effect of laparoscopic myomectomy combined with preoperative gonadotropin releasing hormone agonists (GnRH-a) in treating myoma patients with uterus volume large than 12 weeks of pregnancy size. Methods 46 patients with uterine volume over 12 gestational weeks from August 2009 to August 2016 were selected as research objects. Leuprolide was injected subcutaneously for three to six times, and then laparoscopic myomectomy was performed one month later. The changes of volumes in uterus and myoma before and after medication were observed as well as the changes of hemoglobin. And postoperative recurrence of uterus myoma was followed up. Results The average volume of the uterus in the 46 patients, detected by B ultrasound, before GnRH-a treatment was (705.47 ± 282.37) cm3, and the average volume of the uterus after GnRH-a treatment was (331.95 ± 84.53) cm3, which was shortened by 59.35%, with significant difference (P < 0.05). The volume of uterus myoma was (237.59 ± 138.46) cm3 before GnRH-a treatment and (81.59 ± 46.44) cm3 after GnRH-a treatment, shortened by 65.66%, with significant difference (P < 0.05). The hemoglobin value was (97.80 ± 20.19) g/L before GnRH-a and (119.63 ± 12.06) g/L after GnRH-a treatment, with significant difference (P < 0.05). Follow-up for 3 weeks to 5 years, the surgeries were accomplished successfully, and no case was transferred to laparotomy. Conclusion Preoperative GnRH-a could shorten volume of uterus myoma, increase hemoglobin value and ensure performance of laparoscopic myomectomy for myoma patients with uterus volume large than 12 weeks of pregnancy size.
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Objective To evaluate the efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the prevention of endometriosis recurrence after conservative surgery.Methods We enrolled patients with medium and severe endometriosis who underwent conservative surgical treatment.All patients were divided into 3 groups:group A in which the patients were administered with 3 cycles of gonadotropin-releasing hormone agonist (GnRH-a) 5 days postoperatively,group B in which the patients were administered with the LNG-IUS 5 days postoperatively,and group C in which the patients were administered with 3 cycles of GnRH-a 5 days postoperatively and the LNG-IUS on the day of the third GnRH-a injection.All patients were followed up at 3,6,12,and 24 months postoperatively.Dysmenorrhea relief was evaluated,and pelvic ultrasound and serum CA125 detection were performed.All treatment-related adverse reactions were recorded.Results Eighty-three patients were included with 21,29,and 33 in groups A,B,and C,respectively.The VAS scores in all 3 groups after 3 months were significantly lower than those obtained preoperatively (P ＜ 0.05).No significant difference was found in the VAS scores after 6 and 12 months among the 3 groups (P ＞ 0.05).After 24 months,the VAS scores in group A were significantly higher than those in the other 2 groups (P ＜ 0.05).Endometriosis recurrence was found in 8 patients after 24 months,with 4 (19.05％),3 (10.71％),and 1 (3.13％) such patient in groups A,B,and C,respectively (P ＜ 0.05).No serious side effects were found.Conclusion Postoperative application of LNG-IUS can effectively prevent recurrence and relieve pain caused by endometriosis,and its combined application with GnRH-a can improve efficacy.
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PURPOSE: This study investigated the influence of obesity on the clinical course and effect of gonadotropin-releasing hormone analog (GnRHa) treatment in girls with central precocious puberty (CPP). METHODS: Medical records of 182 girls with CPP treated with GnRHa were reviewed. They were divided into 2 groups: normal weight (n=108) and overweight/obesity (n=74). Chronological age (CA), bone age (BA), difference between BA and CA (BA–CA), standard deviation score (SDS) of height, body mass index (BMI), predicted adult height (PAH), and laboratory findings were compared at baseline, after 1 year, and at the end of GnRHa treatment in both groups. RESULTS: Mean BMI SDS at baseline was 0.08±0.60 in the normal weight group and 1.55±0.36 in the overweight/obesity group. Initial CA, BA, midparental height, and PAH were similar between the 2 groups. BA–CA after treatment was significantly decreased compared to baseline in both groups (P < 0.001). Between the 2 groups, a decrease in BA–CA during treatment showed no significant difference. PAH at the end of treatment was significantly increased compared to baseline in both groups (P < 0.001). PAH at the end of treatment in the overweight/obesity group (159.88±3.41 cm) was similar to that of the normal weight group (159.19±3.25 cm). Comparing the 2 groups according to change in BMI after treatment, there were no differences in ΔPAH, ΔBA–CA, and Δheight SDS for BA. CONCLUSIONS: GnRHa treatment in obese girls with CPP improved the height outcome and had similar results in normal weight CPP girls. Obesity might not affect the efficacy of GnRHa in girls with CPP.
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Adulto , Femenino , Humanos , Estatura , Hormona Liberadora de Gonadotropina , Registros Médicos , Obesidad , Sobrepeso , Pubertad PrecozRESUMEN
OBJECTIVE: The aim of this study was to evaluate the effect of short-term use of selective progesterone receptor modulator (SPRM) or gonadotropin-releasing hormone (GnRH) agonist on uterine fibroid shrinkage among Korean women. METHODS: This retrospective study involved 101 women with symptomatic uterine fibroids who received ulipristal acetate (SPRM, n=51) and leuprolide acetate (GnRH agonist, n=50) for 3 months between November 2013 and February 2015. The fibroid volume was measured both before and after treatment using ultrasonography, computed tomography, and magnetic resonance imaging. The outcomes were compared between the SPRM and GnRH agonist groups. RESULTS: The median rate of fibroid volume reduction after SPRM treatment was 12.4% (IQR −14.5% to 40.5%) which was significantly lower than the reduction rate observed after GnRH agonist treatment (median 34.9%, IQR 14.7% to 48.6%, P=0.004). 19 of 51 (37.3%) patients with SPRM treatment did not show any response of volume shrinkage, while 7 of 50 (14.0%) women with GnRH agonist showed no response (P=0.007). CONCLUSION: Short-term SPRM treatment yields lower volume reduction than GnRH agonist treatment in Korean women with symptomatic fibroids. Further large-scale randomized trials are needed to confirm our findings.
Asunto(s)
Femenino , Humanos , Hormona Liberadora de Gonadotropina , Leiomioma , Leuprolida , Imagen por Resonancia Magnética , Progesterona , Receptores de Progesterona , Estudios Retrospectivos , UltrasonografíaRESUMEN
Few studies have investigated the long-term effects of gonadotropin-releasing hormone (GnRH) agonist treatment on the reproductive function of central precocious puberty (CPP) girls. In this cross-sectional study, we assessed the ovarian function by analyzing the serum anti-Müllerian hormone (AMH) levels of CPP girls. Our study included 505 CPP girls subdivided into 5 groups according to the GnRH agonist treatment stage: group A (before treatment, n = 98), group B (3 months after initiation, n = 103), group C (12 months after initiation, n = 101), group D (24 months after initiation, n = 101), and group E (6 months after discontinuation, n = 102). We compared the serum AMH levels of the CPP girls with those of 100 bone age-matched controls (before treatment: n = 55; after discontinuation: n = 45). At baseline, the mean AMH level of the CPP girls was 5.9 ± 3.6 ng/mL. The mean AMH level after 3 months of the GnRH agonist treatment was lower (4.7 ± 3.2 ng/mL, P = 0.047) than that at baseline and recovered after 12 months of treatment. Six months after discontinuation, the AMH levels were similar to those at pre-treatment. Before and after the GnRH agonist treatment, the AMH levels were similar to those of the bone age-matched controls. In the precocious puberty girls, the AMH levels based on the GnRH agonist treatment stage were all within the normal reference range. The results of this study suggest that GnRH agonist treatment has no adverse effects on the reproductive function.