不妊治療におけるゴナドトロピンを用いた排卵誘発法の進歩と展開 : hMG律動的皮下投与法を中心として

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Ovulation was induced by pulsatile subcutaneous administration of hMG(150〜300 IU of FSH per day)at 90 minutes intervals without administration of GnRH agonist(hMG method)in anovulatory women with polycystic ovary syndrome(PCO, 114 cycles of 20 women), degree I of amenorrhea which was diagnosed when withdrawal bleeding was induced by an injection of 25 mg progesterone(102 cycles of 26 women), and degree II of amenorrhea which was diagnosed when withdrawal bleeding was induced by an injection of 5mg estrogen and 50 mg progesterone but not by an injection of 25 mg progesterone alone(106 cycles of 19 women). In women with PCO, successful ovulation was induced in 102 cycles of 20 women, pregnancy was achieved in 18 cycles of 12 women, and ovarian hyperstimulation syndrome(OHSS)occurred in 40 cycles of 16 women. In women with degree I of amenorrhea, successful ovulation, pregnancy and OHSS occurred in 92 cycles of 26 women, 20 cycles of 17 women, and 42 cycles of 18 women, respectively. In women with degree II of amenorrhea, successful ovulation, pregnancy and OHSS happened in 101 cycles of 19 women, 17 cycles of 12 women, and 42 cycles of 15 women, respectively. In 41 cycles of 9 women with PCO, ovulation was induced by pulsatile administration of hMG under pituitary desensitization with nasal administration of GnRH agonist(GnRH against + hMG method). Ovulation, pregnancy, and OHSS occurred in 27 cycles of 9 women, 2 cycles of 2 women, and 3 cycles of 1 women, respectively. In total, multiple pregnancy happened in 7 cycles of 7 women, consisting of one quintplet, one triplet, and 5 twin pregnancies. The induction of ovulation by pulsatile subcutaneous administration of hMG has excellent characteristics as follows : 1) the high rates of successful ovulation and pregnancy for various types of anovulation being refractory to therapy by clomiphene citrate, 2) a low incidence of multiple pregnancy, 3) unnecessity of daily visit to outpatient clinic, in contrast to conventional daily intramuscular administration of hMG, and 4)significant decreases in an incidence of OHSS as well as the rates of ovulation and pregnancy by the GnRH agonist + hMG method. Although occurrence of OHSS and a higher incidence of multiple pregnancy than natural conception cannot be prevented completely by pulsatile administration of hMG and other recent attempts, the severity and incidnence of these complications are decreased, compared with conventional intramuscular administration of hMG. In near future, the induction of ovulation without complications almost similar to natural ovulation will be expected by pulsatile subcutaneous administration of recombinant FSH and LH at various ratios under suppression of endogenous FSH and LH by GnRH antagonist.
社団法人日本産科婦人科学会の論文
2001-09-01

不妊治療におけるゴナドトロピンを用いた排卵誘発法の進歩と展開 : hMG律動的皮下投与法を中心として

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