Ovarian Stimulation for
IVF Procedures
Dr Milton Leong
梁家康醫生
微剂量Flare法(1)
口服避孕药
 皮下注射20mcg 亮丙瑞林 （一天两次）X2天
 应用uFSH 以刺激卵巢
 结果:
 卵母细胞
FSH使用量少

Source: Scott et al, 1994
微剂量Flare法(2)





口服避孕药
皮下注射40mcg 亮丙瑞林 （一天两次）
肌注4 IU/d 生长激素
使用uFSH 2 天后监测
结果:
 取消率
 E2 浓度, 卵母细胞数目
Source: Schoolcraft et al, 1997
微剂量Flare法(3)
口服避孕药
 皮下注射40mcg 亮丙瑞林 （一天两次）
 2天后开始应用uFSH
 结果:
 取消率
 E2, 卵母细胞数目

Source: Surrey et al, 1998
延长停药时间 (1)

目的: 避免过度刺激

临床: 直至 E2  3000 pg/mL停药
延长停药时间(2)
Sher, 1995
当30% 卵泡 > 15mm开始
Nilsson, 1999
当3 个卵泡 > 17mm开始
GnRHa 剂量组
曲普瑞林
(mcg)
病例数
刺激天数
FSH使用量
S7-LH
HCG-LH
排卵
5
15
50
100
11
9
24
3.3
2.5
3
10
7.5
22.5
1.5
2.3
0
11
10
27
1.3
1.8
0
12
10.5
28.5
0.8
0.9
0
Source: Janssens et al, 1998
Mean SE  E2 and LH conc. Before and during the
coasting period in superovluation cycles
Characteristics of representative IVF-ET cycles in
which coasting was used
General Principles of combined pituitary suppression /
ovarian stimulation therapy (From Insler and Lunenfeld)
Clinical pregnancy per cycle start (%)
Crude pregnancy rates using different GnRH agonist
protocols in IVF (From Daya)
30
23.2
25
20
18.9
20.5
15
10
5
0
Short
Ultrashort
GnRH-a protocols
Long
The structure of GnRH agonistic analogues
Outcome results according to type of protocol and
gonadotrophin used (n=13426)
Oocyte damage, pronuclear status and embryo
cleavage after ICSI
Trade names, plasma half-lives, relate potency, route of
administration and recommended dose for the clinically
available gonadotrophins
Proposed protocols for poor responders
Characteristics of IVF-ET cycles in which follicular
maturity was attained before (gp 2A) or after (gp 2B)
the coasting period
Gonadotropin and ovarian steroid hormone levels with
microdose flare regimen:
gonadotropin treatment day 1 vs day 6
Comparison of conventional IVF and ICSI procedure on
sibling oocytes of 50 patients with tubal infertility
Outcome of embryo transfers after ICSI
Schematic representation of different protocols using
GnRH agonists in combination with gonadotrophins for
ovarian stimulation in IVF
Regimen@
Lupron
Decapeptyl® 0.1
Alternate-day
Decapeptyl® 0.1
7-day
Total Cycle initiated
20
15
20
37.6 (32-44)
35.4 (32-42)
38.8 (36-44)
4.4
2.4
2.7
2.2
1.6
1.5 (P<0.05)
2.7
1.9
2.4
48.5
2473
35.0
1429
45.9
1760
Mean Age (range)
Serum LH (IU/L)
Day 3
Day 7
Day of hCG
Serum E2 (pmol/L)
Day 3
Day of hCG
Regimen@
Lupron
Decapeptyl® 0.1
Alternate-day
Decapeptyl® 0.1
7-day
Total Cycle initiated
20
15
20
37.6 (32-44)
35.4 (32-42)
38.8 (36-44)
10
74
5
25.0
6.5
77
2
13.4
9.6
86
6
30.0
Mean Age (range)
Means
# of eggs
% fertilized
# clinical pregnancy
pregnancy rate %