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卵泡期长效长方案中,由于垂体功能受抑制使LH处于低水平,将造成雌激素合成减少,卵泡发育速度减慢。该方案启动日不需要常规添加LH。但对于以下3种人群:前次周期卵巢低反应、35岁以上的高龄和慢反应人群(即卵巢刺激第8天无直径大于1cm的卵泡),适时添加LH,可以增加卵巢的反应性,缩短促排卵药物的使用时间。使用卵泡期长效长方案的目的是最大化新鲜胚胎移植。扳机标准主要由主导卵泡径线大小来决定,当三分之二的卵泡直径达到16mm同时综合考虑卵泡数目、雌激素及孕酮水平、年龄和既往治疗情况决定最佳的扳机时机。为避免卵巢过度刺激风险,高反应患者建议在雌激素水平低于3 000～4 000pg/ml(10 980～14 640pmol/L),目标获卵数少于18枚时提早扳机,并减少HCG用量,从而赢得新鲜移植的机会。
Abstract：In long-acting GnRH agonist(GnRH-a)long protocol in follicular phase,because pituitary function is inhibited,LH is at a low level and estrogen synthesis is reduced,and the speed of follicular growth slows down.It's unnecessary to add LH routinely in this protocol.However,use of LH is recommended in the three kinds of patients,including the women with poor response in a previous cycle,or age>35 year,or suboptimal follicular progression in a current cycle(no follicle size>10 mm on day 8).Adding LH in the middle and late stages of follicular development can increase ovarian response and shorten the use time of inducing ovulation drugs.The purpose of choosing the long-acting GnRH-a long protocol in follicular phase is to maximize the fresh embryo transfer.The proper selection of trigger timing depends on the follicle size mainly.When two-thirds of follicles reach 16 mm in diameter,the optimal trigger timing is also determined by considering follicle number,estrogen and progesterone levels,age and previous treatment.To avoid the high risk of ovarian hyperstimulation syndrome(OHSS),it suggests to trigger earlier when the E2 is 3 000-4 000 pg/ml(10 980-14 640 pmol/L)and the number of the target oocytes retrieval is less than 18,and should reduce HCG dose,in order to get the chance for fresh embryo transfer.
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基本信息:
中图分类号:R714.8
引用信息:
[1]林芸,徐嘉文.卵泡期长效长方案促排卵晚期的思考[J].生殖医学杂志,2019,28(10):1133-1136.
2019-10-12
2019-10-12