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促性腺激素释放激素激动剂(GnRH-a)已经广泛地应用于体外受精(IVF)垂体降调节中。GnRH-a分长效和短效两种剂型,长效剂型患者接受性和依从性高,但有卵巢过度抑制倾向,会造成促性腺激素(Gn)用量增加、使用时间延长,因而增加经济负担,而短效者可接受性和依从性较差。两者临床效果无显著差异。临床上常用的GnRH-a降调节方案有长、超长、短、超短等方案,各种方案的临床效果总体上并无显著差异但各有优缺点,通常卵巢功能减退的患者建议给予短方案,甚至超短方案,而卵巢储备功能正常患者常用长方案。超长方案对于合并子宫内膜异位症或多囊卵巢综合征患者等能提高临床妊娠率。降调标准存在争议,因此文献报道对于Gn的启动时间亦有不同,需要根据患者个体及不同的降调节方案而定。适当延迟启动时间可能改善卵母细胞的质量和内膜接受性,从而提高临床妊娠率,而且适当推迟Gn启动时间对于减少Gn的用量,降低患者的经济负担也是十分有益的。
Abstract：Gonadotrophin-releasing hormone agonist(GnRH-a) has been widely used in the pituitary down-regulation.There are two forms of GnRH-a,long-and short-acting.These two types of GnRH-a show comparable clinical efficacy,with good acceptability and patient compliance but risk of over suppression of ovary for long-acting form,while disadvantages in acceptability and patient compliance for short-acting form.There are several protocols for down-regulation in clinical application,including long, super-long,short and super-short protocols,with different advantages and disadvantages.In general,the individualized protocol is the best one.As the identification of down-regulation is controversial,the timing of initiation of gonadotropin administration is different in different reproductive center or in different studies,which is largely dependent on the down-regulation protocols used and patient characteristics.In some existing evidence,delayed initiation showed no detrimental effects on the treatment outcomes,but may improve the quality of retrieved oocytes and endometrial receptibility,resulting in a higher pregnancy rate.In addition,the properly delayed initiation of gonadotropin administration could reduce the ampules of gonadotropin used,offering an economic benefit for the patients.
[1]Porter RN.Smith W,Craft L,et al.Induction of ovulation for in vitro fertilization using buserelin and gonadotropins[J]. Lancet,1984,2(8414):1284-1285.
[2]van Voorhis BJ.Clinical practice.In vitro fertilization[J].N Engl J Med,2007,35(6):379-386.
[3]庄广伦.现代辅助生育技术[M].北京:人民卫生出版社, 2005:111-112.
[4]Yim SF,Lok IH,Cheng LP,et al.Dose finding study for the use of long acting gonadotrophin releasing hormone analoges prior to ovarian stimulation for IVF[J].Hum Reprod, 2001,16(3):492-494.
[5]Albuquerque LE,Saconato H,Maciel MC.Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles[CD].Cochrane Database Syst Rev,2005,(1): CD002808.
[6]Harrison RF,Drudy L,Kinsella CB,et al,A randomized prospective study of early follicular or midluteal initiation of long protocol gonadotrophin-releasing hormone in an in vitro fertilization program[J].Fertil Steril,1996,66(4): 582-586.
[7]Ravhon A,Lanrie H,Ellenbogen A,et al.A prospective, randomized controlled trail comparing the efficacy of recombinant follicle stimulating hormone in there different in vitro fertilization protocols[J].Fertil Sertil,2000,73(5):908-912.
[8]Cramer DW,Powers DR,Oskowitz SP,et al.Gonadotropin releasing hormone agonist use in assisted reproduction cycles:the influence of long and short regimens on pregnancy rates[J].Fertil Sertil,1999,72(1):83-88.
[9]Hazout A,de Ziegler D,Cornel C,et al.Comparison of short 7 day and prolonged treatment with gonadotropin releasing hormone agonist desensitization for controlled ovarian hyperstimulation[J].Fertil Sertil,1993,59(3):596-600.
[10]孙海翔.长方案中有关垂体降调节问题的讨论[J].生殖医学杂志,2008,17(6):407.
[11]王芳,孙莹璞,苏迎春,等.长方案降调节天数和LH水平对体外受精结局的影响[J].现代妇产科进展,2008,17(1):52- 54.
[12]王慧焱,孙海翔,陈华,等.长方案垂体降调节对体外受精-胚胎移植结果的影响[J].生殖与避孕,2009,29(2):84-87.
[13]Loutradis D,Drakakis P,Kallianidis K,et al.The effect of the duration of GnRH-agonist down regulation before ovarian stimulation on the biological and clinical outcome after intracytoplasmic sperm injection[J].Eur J Obstet Gynecol Reprod Biol,1998,80(2):251-255.
[14]Ma C,Qiao J,Liu P,et al.Ovarian suppression treatment prior to in-vitro fertilization and embryo transfer in Chinese women with stageⅢorⅣendometriosis[J].Int J Gynaecol Obstet,2008,100(2):167-170.
[15]Meresman GF,Bilotas M,Buquet RA,et al.Gonadotrop in releasing hormone agonist induces apoptosis and reduces cell proliferation in ectopic endometrial cultures from women with endometriosis[J].Fertil Steril,2003,80(Supp 12): 702- 707.
[16]盛燕霞,马彩虹,杨蕊,等.不同控制促排卵方案对子宫腺肌病患者体外受精-胚胎移植结局的影响[J].生殖与避孕, 2010,32(6):375-378.
[17]沙爱国,任建枝,韩冬梅,等.改良长降调节方案在子宫内膜异位症患者体外受精-胚胎移植中的应用[J].第三军医大学学报,2010,32(15):1682-1683.
[18]Gong F,Tang Y,Zhang H,et al.Modified super-long down-regulation protocol improved the outcome of in vitro fertilization-embryo transfer in infertile patients[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2009,34(3),185-189.
[19]李豫峰,王华丽,何巧花,等,使用GnRH-a后完全降调节与否与IVF结局的研究[J].中国优生与遗传杂志,2008,16 (6):120-123.
[20]Cedrin-Durnerin I,Massin N,Galey-Fontaine J,et al.Timing of FSH administration for ovarian stimulation in normoovulatory women:comparison of an early or a mid follicular phase initiation of a short term treatment[J].Hum Reprod, 2006,21(11):2941-2947.
[21]马黔红,李尚为,黄仲英,等.长效促性腺激素释放激素激动??剂用于体外受精-胚胎移植中降调节后延迟卵巢启动时间的探讨[J].实用妇产科杂志,2006,22(10):603-606.
[22]胡琳莉,朱桂金.促性腺激素启动时间对IVF结局的影响[J].中国实用妇科与产科杂志,2009,25(2):133-135.
[23]De Placido G,Alviggi C,Perino A,et al.Recombinant human LH supplementation versus recombinant human FSH (rFSH) step up protocol during controlled ovarian stimulation in normogonadotrophic women with initial inadequate ovarian response to rFSH:a multicentre,prospective,randomized controlled trial[J].Hum Reprod,2005,20(2). 390-396.
[24]Tesarik J,Mendoza C.Effects of exogenous LH administration during ovarian stimulation of pituitary down regulated young oocyte donors on oocyte yield and developmental competence [J].Hum Reprod,2002,17(12):3129-3137.
[25]Fleming R,Chung CC,Yates RW,et al.Purified urinary follicle stimulating hormone induces different hormone protiles compared with menotrophins,dependent upon the rote if administration and endogenous luteinizing hormone activity [J].Hum Reprod,1996,11(9):1854-1858.
[26]卢先艳,胡娅莉,孙海翔.GnRHa降调节后月经第3天的FSH/LH比值预测卵巢的反应性[J].中国妇产科临床杂志,2007,8(4):249-251.
[27]Ho JY,Guu HF,Yi YC,et al.The serum follicle-stimulating hormone-to-luteinizing hormone ratio at the start of stimulation with gonadotropins after pituitary down-regulation is inversely correlated with a mature oocyte yield and can predict "low responders"[J].Fertil Steril,2005,83(4): 883-888.
[28]Barroso G,Oehninger S,Monzo A,et al.High FSH:LH ratio and low LH levels in basal cycle day 3:impact on follicular development and IVF outcome[J].J Assist Reprod Genet,2001,18(9):499-505.
基本信息:
中图分类号:R714.8
引用信息:
[1]迟洪滨,乔杰,刘平.促性腺激素释放激素激动剂降调节的个体化与促性腺激素启动日时机选择[J].生殖医学杂志,2011,20(S1):12-16+44.
2011-10-15
2011-10-15