en اثر یوتروژستان خوراکی در مقایسه با ستروتاید جهت پیشگیری از افزایش ناگهانی پیش از موعد LH درسیکل IVF Assisted Reproductive Technologies Original Article Original Article <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقدمه: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون خوراکی به عنوان جایگزینی برای آگونیست و آنتاگونیست&shy;های </span></span><span dir="LTR"><span style="font-size:10.0pt;">GnRH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">برای جلوگیری از افزایش ناگهانی پیش از موعد </span></span><span dir="LTR"><span style="font-size:10.0pt;">LH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در سیکل</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">پیشنهاد شده است. با این حال، اطلاعات موجود در رابطه با استفاده آن کم می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">باشد.</span></span><strong><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;"></span></span></span></strong><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف از این مطالعه ارزیابی اثر یوتروژستان خوراکی در مقایسه با ستروتاید (آنتاگونیست </span></span><span dir="LTR"><span style="font-size:10.0pt;">GnRH</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) جهت پیشگیری از افزایش ناگهانی پیش از موعد </span></span><span dir="LTR"><span style="font-size:10.0pt;">LH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در سیکل </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">باشد.</span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مواد و روش &shy;ها:</span></span></strong> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در این مطالعه کارآزمایی بالینی، 100 زن نابارور که تحت </span></span><span dir="LTR"><span style="font-size:10.0pt;">ART</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">قرار می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گرفتند و </span></span><span dir="LTR"><span style="font-size:10.0pt;">FSH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">نوترکیب (</span></span><span dir="LTR"><span style="font-size:10.0pt;">GonalF, Merck serono</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">) با دوز 225-150 </span></span><span dir="LTR"><span style="font-size:10.0pt;">IU</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">روزانه می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گرفتند، به طور تصادفی جهت دریافت یوتروژستان 100 میلی</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گرم دو بار در روز (گروه مورد) یا پروتکل آنتاگونیست </span></span><span dir="LTR"><span style="font-size:10.0pt;">GnRH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">(گروه کنترل) از روز سوم چرخه تا روز هدف تقسیم شدند. </span></span><span dir="LTR"><span style="font-size:10.0pt;">Triggering</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با 10000 واحد </span></span><span dir="LTR"><span style="font-size:10.0pt;">hCG</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">انجام شد زمانی که حداقل 3 فولیکول به قطر متوسط بالای 17 &nbsp;&nbsp;&nbsp;میلی</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">متر رسیده بودند. جنین</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های قابل حیات در هر دو گروه برای انتقال بعدی کرایوپرزرو شدند. تعداد فولیکول</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های بالغ، تعداد جنین</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های منتقل شده و میزان بارداری بین دو گروه مقایسه شدند.</span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتایج: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه مورد بطور بارزی سطح پروژسترون بالاتری در زمان </span></span><span dir="LTR"><span style="font-size:10.0pt;">trigger</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">، فولیکول</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های بالای 14 میلی</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">متر بیشتری با فولیکول</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های بالغ بزرگتر، اووسیت</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">های برداشت شده با میزان بالاتر جنین منتقل شده داشتند. افزایش اندکی در میزان بارداری در گروه مورد مشاهده شد که تفاوت بارزی بین دو گروه وجود نداشت. نکته مهم این مطالعه عدم مشاهده افزایش ناگهانی پیش از موعد </span></span><span dir="LTR"><span style="font-size:10.0pt;">LH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در هیچ یک از گروه</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">ها بر اساس اندازه</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گیری </span></span><span dir="LTR"><span style="font-size:10.0pt;">LH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در روز </span></span><span dir="LTR"><span style="font-size:10.0pt;">trigger</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">بود.</span></span><br> <strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتیجه&shy; گیری: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">یوتروژستان یک درمان جایگزین می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">باشد که می</span></span><span dir="LTR"><span style="font-family:arial,sans-serif;"><span style="font-size:11.0pt;">&shy;</span></span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">تواند میزان افزایش ناگهانی پیش از موعد </span></span><span dir="LTR"><span style="font-size:10.0pt;">LH</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">را کاهش و پیامد باروری را افزایش دهد.</span></span> <strong>Background:</strong> Oral progesterone is recommended as an alternative to gonadotropin-releasing hormone (GnRH) agonists and antagonists to prevent luteinizing hormone (LH) surge in assisted reproductive technology (ART) cycles. However, there are little data regarding its use.<br> <strong>Objective:</strong> We aimed to compare the effect of oral Utrogestan and Cetrotide (a GnRH antagonist) on preventing LH surge in ART cycles.<br> <strong>Materials and Methods:</strong> In this randomized clinical trial, 100 infertile women undergoing ART who received recombinant follicle-stimulating hormone (FSH) at 150-225 IU/day were randomly assigned to receive either Utrogestan 100 mg twice a day (case group) or GnRH antagonist protocol (control group) from cycle day 3 until the trigger day. Triggering was performed with 10,000 IU hCG) when there were at least three mature follicles. Viable embryos were cryopreserved for transfer in the next cycle for both groups. The number of oocytes retrieved and transfered embryos were compared between groups.<br> <strong>Results: </strong>The case group had significantly higher progesterone levels on triggering day, more follicles of >14 mm with higher maturity, and more oocytes retrieved with a higher rate of embryos transferred. A small increase in the pregnancy rate was observed in the case group, with no significant between-group differences. The most important result was the lack of premature LH surge in either group upon serum LH assessment on the triggering day.<br> <strong>Conclusion:</strong> Utrogestan is an alternative treatment that could reduce the LH surge rate and increase the ART outcomes including number of oocytes retrieved and transfered embryos compared with GnRH agonists and antagonists. باروری آزمایشگاهی, افزایش ناگهانی پیش از موعد LH, یوتروژستان In vitro fertilization, Premature luteinization, Utrogestan 41 46 http://ijrm.ir/browse.php?a_code=A-10-736-1&slc_lang=en&sid=1 Alieh Ghasemzadeh alghasemzade@yahoo.co.uk 0000-0002-0514-5474 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Masumeh Dopour Faliz sahere_dopour@yahoo.com 0000-0002-2925-2899 Yes Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Laya Farzadi farzadl_29@yahoo.com 0000-0001-9969-0352 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Nazli Navali navalinph@gmail.com 0000-0002-3112-8037 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Behzad Bahramzadeh b.bahramzadeh@yahoo.com 0000-0002-5260-5701 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Arash Fadavi arash_fadavi@yahoo.com 0000-0003-3174-5665 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Parvin Hakimi parvin.hakimi56@gmail.com 0000-0002-8402-7459 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Sepideh Tehrani-ghadim sepidehtehrani54@gmail.com 0000-0001-8780-0112 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Sedigheh Abdollahi fard sed.abdollahi@gmail.com 0000-0002-4224-4519 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Kobra Hamdi hamdi_kobra@yahoo.com 0000-0002-5916-7230 No Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.