경구피임약 GnRH-a룰 병합하여 과배란유도를 시행한 체외수정시술에 관한 연구

다국어 초록 (Multilingual Abstract)

Modification of the standard ovulation induction protocols, in the form of suppression of endogenous gonadotropins, has been widely employed in in vitro fertilization and embryo transfer(IVE-ET)to prevent spontaneous luteinizing hormone(LH)surges, to increase scheduling efficiency, and to improve outcome. Recently induction of a transient hypogona- dotropic state with synthetic steroids has been suggested to synchronize follicular develop-ment and to improve estradiol respones to controlled ovarian hyperstimulation(COH)although most attention has been received by gonadotropin-releasing hormone agonists(GnRH-a)for gonadotropin suppression. The purpose of this study was to evaluate the effect of oral contraceptives(OCs) on dedogenous gonadotropin suppression preceded induction of follicle stimulation. From October, 1991 to July 1992,35 patients(study group,46 cycles)were daliy administered 1 pill (ethiny1 estradil1 0.03 mg + gestodene 0.075 mg) of OCs begining on day 5 of menstrual cycle during 21-42 days before COH cycle, and then hMG 150IU/day was started 5 days after stop of OCs administration.63 patients(control group, 63 cycles) were administered subcutaneous Decapeptyl (GnRH-a)0.1 mg/day from day 2` of menstrual cycle, and hMG 150 IU/day was started only after pituitary desensitization had achieved at least 14 days after. Study group was given GnRH-a, for triggering the final stage of follicular maturation and ovrlation induction, but control group was give hCG. We compared serum E2, LH,FSH concentrations on MCD#3, MCD#7, just before and after triggering day and the clinical outcomes in both groups. The results were summerized as follows: 1. No premature LH surage occured in both groups. 2. Serum LH values in study group were progressively decreased than in control group on MCD#3, MCD#7,12 hours just before triggering(P<0.05) 3. Both LH and FSH surge were also observed in study group triggered by GnRH-a 4. LH and FSH surge were normalized after 36 houre in study group triggered by GnRH-a 5. Pregnancy rate was 28.3%(13/46 cycles)in study group and 36.5%(23/63 cycles) in control group. But there was no significant difference in the pregnancy rates between the both group. 6. The length of treatmint with OCs did not have any difference on follicular recruitment, fertilization rate, or pregnancy rate. Our data demonstrate that OCs are useful and effective alternative to GnRH-a in IVF stimulation protocol to facilitate scheduling of cycles, to prevent spontaneous LH surges, and to improve clinical outcomes.