en آیا دوز مجدد gonadotropin releasing hormone agonist trigger در بیماران با تخمدان پلی سیستیک باعث بهبود نتایج In vitro fertilization می گردد؟ 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;"> دوز&shy;های تکراری </span></span><span dir="LTR"><span style="font-size:10.0pt;">Gonadotropin-releasing Hormone (GnRH)</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> می&shy;تواند بطور مناسبی طول مدت </span></span><span dir="LTR"><span style="font-size:10.0pt;">luteinizing hormone (LH)</span></span> <span dir="LTR"><span style="font-size:10.0pt;">surge</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">افزایش دهد.</span></span><span dir="LTR"><span style="font-family:Arial,sans-serif;"><span style="font-size:11.0pt;"></span></span></span><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;">آیا دوز مجدد ١٢ ساعت بعد از اولین دوز </span></span><span dir="LTR"><span style="font-size:10.0pt;">GnRH agonist</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> می&shy;تواند میزان بالا رفتن </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 طولانی کرده و باعث بهبود ماچوریتی اووسیت شود؟</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;">این مطالعه آینده&shy;نگر، دو سوکور در دانشگاه شهید صدوقی انجام شد. تمام بیماران شناخته شده با تخمدان پلی&shy;سیستیک در این مطالعه وارد شده و</span></span> <span dir="LTR"><span style="font-size:10.0pt;">IVF</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">با پروتکل آنتاگونیست بین سال&shy;های ٢٠١٨ و ٢٠١٩ انجام گردید. شرکت&shy;کنندگان با استرادیول سرمی بالاتر از ٣٠٠٠ بر اساس جدول تقسیم تصادفی به دو گروه مجزا تقسیم شدند گروه</span></span> <span dir="LTR"><span style="font-size:10.0pt;">(A</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و گروه</span></span> <span dir="LTR"><span style="font-size:10.0pt;">.B </span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در گروه </span></span><span dir="LTR"><span style="font-size:10.0pt;">B</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تحریک ماچوریتی اووسیت با یک دوز انجام شد که شامل ٢/. میلی&shy;گرم تریپتورلین ٣٥ ساعت قبل از تخمک&shy;گیری بود و در گروه </span></span><span dir="LTR"><span style="font-size:10.0pt;">A</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دوز مجدد ١٢ ساعت بعد از دوز اول که شامل ١/. میلی&shy;گرم بود، تکرار گردید. سطح سرمی استرادیول </span></span><span dir="LTR"><span style="font-size:10.0pt;">E2</span></span><span style="font-size:10.0pt;">،</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;">، پروژسترون 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;">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 شد، سطح سرمی </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 سه زمان در هر دو گروه 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 شد. نتایج شامل میزان تخمک&shy;گیری، </span></span><span dir="LTR"><span style="font-size:10.0pt;">M1</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">M2</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، </span></span><span dir="LTR"><span style="font-size:10.0pt;">Maturity rate</span></span><span style="font-size:10.0pt;">،</span><span dir="LTR"><span style="font-size:10.0pt;">GV rate</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، تعداد جنین و میزان </span></span><span dir="LTR"><span style="font-size:10.0pt;">OHSS</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> بررسی گردید.</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;">میزان </span></span><span dir="LTR"><span style="font-size:10.0pt;">M1</span></span><span style="font-size:10.0pt;">،</span> <span dir="LTR"><span style="font-size:10.0pt;">M2</span></span><span style="font-size:10.0pt;">، </span><span dir="LTR"><span style="font-size:10.0pt;">Maturity rate</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">GV rate</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> در بین دو گروه تفاوتی نداشت. سطح </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;"> ١٢ ساعت بعد از </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;"> ارتباط معناداری با میزان ماچوریتی نداشت. </span></span><span dir="LTR"><span style="font-size:10.0pt;">Empty follicle syndrome (EFS)</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> گزارش نشد.</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;">با دوز مجدد </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;">اگونیست ١٢ ساعت بعد از دوز اولیه می&shy;توان میزان و فرکانس افزایش </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 بهبود بخشید و در نتیجه آن </span></span><span dir="LTR"><span style="font-size:10.0pt;">EFS</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> رویت نشد اما تاثیری بر میزان ماچوریتی اووسیت،</span></span><span dir="LTR"><span style="font-size:10.0pt;">M1 </span></span><span style="font-size:10.0pt;">،</span> <span dir="LTR"><span style="font-size:10.0pt;">M2</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> و </span></span><span dir="LTR"><span style="font-size:10.0pt;">GV</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بین دو گروه نداشت.</span></span><span style="font-family:B Mitra;"><span style="font-size:10.0pt;"></span></span><br> &nbsp;<br> &nbsp; <strong>Background:</strong> A repeat dose of Gonadotropin-releasing Hormone (GnRH) agonist could provide long duration of luteinizing hormone (LH) surge and amplitude appropriately.<br> <strong>Objective:</strong> Improvement in oocyte maturity could be obtained by a repeat dose of GnRH agonist.<br> <strong>Materials and Methods: </strong>In this randomized double-blinded study, 120 women with polycystic ovarian syndrome and serum estradiol level (E2) > 3000 who were candidate for in vitro fertilization with Antagonist protocol were enrolled between July 2018 and July 2019. &nbsp;Participants were randomized in two groups - and final oocyte maturation was triggered with two doses: In group A, a repeat dose of 0.1 mg, 12 hr. after the first dose and in group B, 0.2 mg SC triptorelin (decapeptyl) 35 hr. prior to oocyte retrieval. Serum Estradiol, LH, and progesterone concentration were measured on the trigger day. Serum LH measurement was done three times in both groups. The outcomes were oocyte yield, meiosis (M) I, MII, Maturity rate, germinal vesicle (GV) rate, 2 pronuclear, embryo yield, ovarian hyper stimulation syndrome rates.<br> <strong>Results:</strong> Maturity rate (p= 0.89), MI (p= 0.38), MII (p= 0.89), and GV oocytes (p= 0.38) were not statistically different between the two study groups. LH levels measured at 12 hr post-trigger did not relate statistically significant with maturity rate in our participants (p= 0.96). No empty follicular syndrome was reported.<br> <strong>Conclusion:</strong> Although, the second dose of GnRH agonist after 12 hr since the first dose could provide duration of LH surge and amplitude and as a result no empty follicular syndrome was seen, the maturity rate, MI, MII, and GV oocytes were not different between the two study groups.<br> &nbsp; سندروم تخمدان پلی­کیسسیت, درمان, لقاح آزمایشگاهی, هورمون آزاد­کننده گنادوتروپین. Polycystic ovarian syndrome, Treatment, In vitro fertilization, Gonadotropin-Releasing hormone. 485 490 http://ijrm.ir/browse.php?a_code=A-10-507-1&slc_lang=en&sid=1 Abbas Aflatoonian abbas_aflatoonian@yahoo.com 0000-0002-2896-6136 No Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Science, Yazd, Iran. Fatemeh Haghighi dr.haghighi120832@gmail.com 0000-0002-3938-8511 Yes Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Science, Yazd, Iran. Masrooreh Hoseini masroorehhoseini@gmail.com 0000-0002-1696-7668 No Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Science, Yazd, Iran. Saeid Haghdani saeed_haghdani@yahoo.com 0000-0002-8025-5753 No Department of Urology, Hasheminejad Kidney Research Center (HKRC), Iran University of Medical Science, Tehran, Iran.