Ovarian hyperstimulation syndrome (OHSS) is a life-threatening iatrogenic complication of ovulation induction. Before ovarian stimulation, identification of patients vulnerable to developing OHSS is necessary. And ovarian stimulation should be started with low doses of gonadotropin or GnRH antagonist protocol. During monitoring of ovarian stimulation with risk of OHSS, coasting, low doses hCG and GnRH agonist for triggering ovulation are considered. If severe OHSS is predicted, cycle cancellation and cryopreservation of all embryos should be considered to reduce late-onset OHSS and morbidity. And metformin and dopamine agonist for reducing OHSS are being proposed as a prophylactic treatment for OHSS.
Cryopreservation ; Dopamine Agonists ; Embryonic Structures ; Female ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Metformin ; Ovarian Hyperstimulation Syndrome ; Ovulation ; Ovulation Induction ; Risk Factors

CA-125 Antigen ; blood ; Estradiol ; blood ; Female ; Gonadotropin-Releasing Hormone ; adverse effects ; agonists ; Humans ; Middle Aged ; Thromboembolism ; chemically induced

OBJECTIVETo evaluate the impact of the concentration of circulating luteinizing hormone (LH) in the late-follicle phase on the outcome of in vitro fertilization for normogonadotrophic women.

METHODSIntracytoplasmic sperm injection treatment was conducted in 432 consecutive cycles of normogonadotrophic women. A stimulation protocol with mid-luteal gonadotropin-releasing hormone (GnRH) agonist down-regulation and ovarian stimulation with follicle stimulating hormone (FSH) was used in all cycles. hMG was added when a follicle of > or = 14 mm was present (FSH + hMG group), not in the control group (FSH-alone). LH and oestradiol concentration in the serum on hCG day were detected. Based on LH levels, patients in the FSH + hMG group were again divided into four subgroups: LH < or = 1, 1 < LH < or = 2, 2 < LH < or = 3, and 3 < LH < or = 10 IU/L.

RESULTSOestradiol concentration on the day of hCG injection in the FSH + hMG group was higher than that in the FSH-alone group [(3435.51 +/- 2029.01) pg/ml vs (2620.62 +/- 1604.80) pg/ml, P < 0.05]. More embryos were transferred in the FSH-alone group than in the FSH + hMG group [(2.77 +/- 0.45) vs (2.22 +/- 0.46), P <0.001]. Fertilization rate, implantation rate, and clinical pregnancy rate were similar between the FSH-alone group and the FSH + hMG group (77.52% vs 78.31%, 41.42% vs 41.68%, 64.56% vs 62.64%, P > 0.05), as well as among the four subgroups of the FSH + hMG group (P > 0.05).

CONCLUSIONThe adding of suitable amount of hMG and physiologically limited LH concentration in the late-follicle phase have no negative effect on the outcome of in vitro fertilization/intracytoplasmic sperm injection for normogonadotrophic women.

Adult ; Down-Regulation ; Estradiol ; blood ; Female ; Fertilization in Vitro ; Follicle Stimulating Hormone ; therapeutic use ; Follicular Phase ; Gonadotropin-Releasing Hormone ; agonists ; Humans ; Luteinizing Hormone ; blood ; Ovulation Induction ; Treatment Outcome

OBJECTIVETo explore the effects of obesity on the peak level of luteinizing hormone (LH) in the gonadotropin-releasing hormone (GnRH) agonist test and obesity-related hormones in girls with central precocious puberty (CPP).

METHODSThree hundred and thirty-three girls with CPP who underwent the GnRH agonist test between 2012 and 2014 were classified into three groups: normal weight (n=123), overweight (n=108), and obesity (n=102), according to body mass index (BMI). The sexual development indices were compared between the three groups. Twenty girls were randomly selected from each group for evaluation of the serum levels of leptin, sex hormone binding globulin (SHBG), neurokinin B, and kisspeptin. The correlation of BMI with the levels of various hormones was assessed using Pearson correlation analysis.

RESULTSThere was no significant difference in mean age at diagnosis between the three groups; however, the bone age was significantly higher in the overweight and obesity groups than in the normal weight group (P<0.05). The peak level of LH in the GnRH agonist test and SHBG level in the normal weight group were significantly higher than those in the overweight and the obesity groups, while the serum levels of leptin and neurokinin B were significantly lower in the normal weight group than in the overweight and the obesity groups (P<0.05). BMI was negatively correlated with the peak level of LH in the GnRH agonist test and SHBG level (P<0.05), and positively correlated with the levels of leptin and neurokinin B (P<0.05).

CONCLUSIONSThe effects of BMI on the result of the GnRH agonist test and levels of obesity-related hormones should be taken into account in girls with precocious puberty.

Body Mass Index ; Child ; Female ; Gonadotropin-Releasing Hormone ; agonists ; Humans ; Leptin ; blood ; Luteinizing Hormone ; blood ; Neurokinin B ; blood ; Obesity ; blood ; Puberty, Precocious ; blood ; Sex Hormone-Binding Globulin ; analysis

OBJECTIVETo observe the effect of Kuntai Capsule (KC), a Chinese patent medicine, in add-back therapy for gonadotropin-releasing hormone agonist (GnRH-a) treatment for moderate-severe endometriosis (EM).

METHODSTotally 100 patients suffering from stage III/IV EM, who were confirmed by laparoscopic surgery were randomly assigned to the GnRH-a group (A) and the KC combined GnRH-a group (B), 50 in each group. Patients in Group A were hypodermically injected with goserelin (3.6 mg), once per 4 weeks. Those in Group B additionally took KC, 4 pills each time, three times per day. The therapeutic course for all was 12 weeks. Serum levels of estradiol (E2), follicle stimulating hormone (FSH), bone gamma-carboxyglutamic-acid-containing proteins (BGP) were measured respectively. Kupperman Menopausal Index (KMI) and bone mineral density (BMD) of the lumbar vertebra were also compared between the two groups.

RESULTSSerum levels of E2 and FSH both significantly decreased in the two groups at week 12 of the treatment (P < 0.05), when compared with pre-treatment. Compared with before treatment in the same group, KMI increased in the two groups (P < 0.05). Compared with before treatment in the same group, BMI decreased in the two groups with no statistical difference (P > 0.05). Serum BGP increased after 12-week treatment (P < 0.05). Compared with Group A after treatment, serum levels of E2 and FSH both significantly increased in Group B (P < 0.05). There was no statistical difference in KMI between the two groups (P > 0.05). As for the incidence of menopausal symptoms, better effects in improving symptoms such as hot flashes, sleep disorders, and vaginal dryness were obtained in Group B than in Group A (P < 0.05). There was no significant difference in the post-pre-treatment difference of BMI between the two groups, but with statistical post-pre-treatment difference in the BGP level (P < 0.05).

CONCLUSIONSHKC combined GnRH-a could effectively reduce GnRH-a treatment induced partial low estrogen symptoms, improve increased serum BGP levels after GnRH-a therapy.

Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Endometriosis ; drug therapy ; Estradiol ; blood ; Female ; Follicle Stimulating Hormone ; blood ; Gonadotropin-Releasing Hormone ; agonists ; Humans

OBJECTIVETo evaluate the application of gonadotrophin-releasing hormone antagonist (GnRH-ant) in patients with risk of poor response to controlled ovarian stimulation in IVF-ET.

METHODSClinical data of 48 patients undergoing IVF with or without ICSI were retrospectively analyzed. Among them 24 patients were allocated to the GnRH-ant protocol and 24 to the long gonadotrophin-releasing hormone agonist (GnRH-a) protocol. The duration of down-regulation, duration of stimulation, amps of gonadotropin estradiol level on hCG day, number of oocytes retrieved, fertilization rate, total embryos obtained, high quality embryo obtained, embryos transferred, embryos frozen, implantation rate per transfer, clinical pregnancy rate per transfer, embryo survival rate, clinical pregnancy rate per frozen embryos transfer and per cycle were compared between two groups.

RESULTThe duration of down-regulation, duration of stimulation, the amps of gonadotropin were significantly lower in the antagonist group than those in agonist group (P <0.001, <0.05, <0.05), the estradiol level on hCG day, the number of oocytes retrieved were significantly lower in the antagonist group than those in the agonist group (P<0.05, <0.05). No significant differences were noted in fertilization rate, total embryos obtained, high quality embryo obtained, embryos transferred, embryos frozen, implantation rate per transfer, clinical pregnancy rate per transfer, embryo survival rate, clinical pregnancy rate per frozen embryos transfer and per cycle.

CONCLUSIONCompared with long GnRH-a protocol, the GnRH-ant protocol in patients with risk of poor response can reduce the dosage of gonadotropin and shorten the duration of stimulation, although the estradiol level on hCG day and the number of oocytes retrieved are lower, which does not affect the implantation rate and clinical pregnancy rate.

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; agonists ; antagonists & inhibitors ; Hormone Antagonists ; pharmacology ; therapeutic use ; Humans ; Infertility, Female ; therapy ; Ovulation Induction ; methods ; Retrospective Studies

OBJECTIVETo develop a new method for predicting adult height (PAH) based on the theory of Bayley-Pinneau and to evaluate the feasibility of this method in predicting adult height of girls with idiopathic central precocious puberty (ICPP) who were treated with gonadotropin releasing hormone agonist (GnRHa).

METHOD(1) The new method for PAH, i.e. PAH = Height/percentage of adult height for bone age, was established according to the theory of Bayley-Pinneau and the data from the national growth survey of children in the nine cities of China in the year 2005. (2) Data from seventeen female patients with ICPP received GnRHa treatment and achieved final adult height (FAH) were collected. Before and during the treatment, PAH was calculated by the method of Bayley-Pinneau and the new method.

RESULTThe mean FAH(cm) of the 17 patients with ICPP was 159.81 ± 4.95. The PAH (cm), before and after treatment for 1, 2 and 3 years, were 156.53 ± 3.63, 157.71 ± 3.62, 158.60 ± 3.50, 161.46 ± 4.50 and 161.56 ± 3.77, 161.68 ± 3.44, 162.04 ± 4.42, 163.13 ± 2.36 respectively by using the new method (PAH-D) and Bayley-Pinneau method(PAH-BP). The mean value of (PAH-D-FAH) and (PAH-BP-FAH) were -1.96 cm and 1.48 cm. However, the 95% confidence interval was (-3.82 cm to -0.11 cm), (-1.60 cm to 4.55 cm) for (PAH-D-FAH) and (PAH-BP -FAH). There was no significant difference between the values obtained before and after treatment in terms of PAH by use of Bayley-Pinneau method. By the new method, however, the results showed that the PAH increased and improved further with prolonged treatment periods. And at the end of treatment, there was no significant difference between PAH and FAH. The correlation coefficient was 0.93. Regression analysis showed that the trend line was in parallel with baseline data.

CONCLUSIONThe new method we established could predict better the final heights of girls with CPP who were treated with GnRHa.

Adult ; Body Height ; Child ; China ; Drug Therapy, Combination ; Female ; Gonadotropin-Releasing Hormone ; agonists ; Human Growth Hormone ; Humans ; Puberty, Precocious ; drug therapy ; Reference Values

OBJECTIVE: To evalvate efficacy of Qizi Yusi Pills (QYP), a Chinese medicine compound preparation, on in vitro fertilization-embryo transfer (IVF-ET) in women of advanced reproductive age. METHODS: This multicenter, randomized, double-blind, placebo-controlled trial was conducted from June 2018 to October 2019. A total of 124 patients were randomly allocated to either the QYP group or the placebo group using a stratified block randomization design, with 62 patients in each group. All patients completed controlled ovarian stimulation using a standard gonadotropin-releasing hormone agonist (GnRH-a) long protocol. As the QYP group, QYP was administered while the control group received placebo. QYP and placebo were administered for a total of 24 to 30 days from the day of GnRH-a pituitary downregulation to transvaginal oocyte retrieval. Both medications were taken orally at doses of 10 g three times each day. The primary outcome was cumulative pregnancy rate, and the secondary outcomes were periodic medication, follicular status, serum hormone and endometrial receptivity. Follow-up continued until 4 weeks after delivery. Maternal and neonatal complications, such as gestational diabetes, were also observed. RESULTS: Overall, 119 patients completed the study, 60 in the QYP group and 59 in the placebo group. Per protocol (PP) analysis revealed that 6-month cumulative pregnancy rate in the QYP group was significantly higher than that in the placebo group [43.33% (26/60) vs. 25.42% (15/59), P=0.040). Additionally, more oocytes were retrieved from the QYP group than those from the placebo group (8.95 ± 3.12 vs. 7.85 ± 1.91, P=0.022). Moreover, the endometrial thickness of HCG day in the QYP group was significantly higher than that in the placebo group (11.78 ± 2.27 mm vs. 10.68 ± 2.07 mm, P=0.012). Maternal and neonatal complications between the two groups were not significantly different (P>0.05). Intention-to-treat analysis was in line with PP results. CONCLUSIONS QYP can enhance ovarian reserve capacity and ovarian response, and possibly promote endometrial receptivity. QYP effectively improves cumulative pregnancy rates in older patients (⩾35 years) undergoing IVF-ET. (Registration No. ChiCTR1800014427).
Drugs, Chinese Herbal/therapeutic use* ; Embryo Transfer ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone/agonists* ; Humans ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

OBJECTIVE: To investigate the inhibitory effect of gonadotropin-releasing hormone II(GnRHII) and gonadotropin-releasing hormone I agonist (GnRH Ia) on the proliferation of endometrial stromal cells in vitro from endometriosis patients. METHODS: Different concentrations of GnRHII or GnRH Ia were added into the cultured endometrial stromal cells in vitro to detect the cell proliferation inhibition by MTT test. RESULTS: The inhibitory rate of GnRHII or GnRH Ia on eutopic and ectopic endometrial stromal cells in vitro was both dose- and time-dependent (P<0.05). Effect of GnRHII or GnRH Ia on the inhibitory rate of ectopic endometrial stromal cells was significantly higher than that of eutopic (P<0.05). GnRH II had a higher inhibitory rate on the endometrial stromal cells in vitro than did GnRH Ia (P<0.05). CONCLUSION GnRHII has more antiproliferative effect on endometrial stromal cells than GnRH Ia in vitro, especially on ectopic endometrial stromal cells, suggesting that GnRHII may be more effective than GnRH Ia on endometriosis.
Adult ; Cell Proliferation ; drug effects ; Cells, Cultured ; Endometriosis ; pathology ; Endometrium ; metabolism ; pathology ; Female ; Gonadotropin-Releasing Hormone ; agonists ; analogs & derivatives ; pharmacology ; Humans ; Middle Aged ; Stromal Cells ; pathology ; Young Adult

OBJECTIVETo compare the outcomes achieved by GnRH-antagonist and GnRH-agonist in IVF-ET for patients with poor ovarian responses, and to find out a better protocol for ovulation stimulation.

METHODS(1) Patients with poor ovarian responses were assigned to an experimental (n = 63) and a control group (n = 58), treated respectively with GnRH-Ant and oral contraceptive plus micro-dose GnRH-a (OC + GnRH-a), and comparisons were made of the medication doses, laboratory results and pregnancy outcomes between the two groups. (2) Twenty of the patients were treated first with GnRH-Ant and then with OC + GnRH-a, and the same comparisons were made between the two protocols.

RESULTSBetween the experimental and the control groups, there were no significant differences in the dose of Gn and number of retrieved oocytes and transplanted embryos (P > 0.05), nor in the pregnancy rate of transplantation cycles (37.29% vs 35.29%). The cycle cancellation rate was lower in the experimental than in the control group (6.35% vs 12.07%), with no statistical difference (P > 0.05). The cycle duration was significantly different between the two groups ([9.65 +/- 1.60] d vs [19.05 +/- 3.94] d) (P < 0.05). As for the comparison of GnRH-Ant with GnRH-a, no significant differences were observed in the dose of Gn and the numbers of retrieved oocytes and transplanted embryos (P > 0.05). GnRH-Ant achieved a higher pregnancy rate of transplantation cycles but a significantly lower cancellation rate than GnRH-a (38.09% vs 17.64% and 0% vs 15%) (P > 0.05 and P < 0.01), respectively. The cycle duration of the former was statistically shorter than that of the latter ([9.91 +/- 2.49] d vs [27.74 +/- 25.39] d) (P < 0.05).

CONCLUSIONCompared with micro-dose GnRH-a, GnRH-Ant can shorten the cycle duration and reduce the cancellation rate in IVF-ET for patients with poor response. And for those who have failed to respond to GnRH-a, GnRH-Ant may be tried in another attempt at IVF-ET.

Adult ; Embryo Transfer ; methods ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; agonists ; antagonists & inhibitors ; physiology ; Humans ; Infertility, Female ; physiopathology ; therapy ; Ovulation Induction ; methods ; Pregnancy ; Pregnancy Rate ; Treatment Outcome