超排卵的新创意

Innovation in controlled ovarian stimulation

达菲林IVF训练营已经持续了5年多，今年是第六年，其特点是围绕超排卵降调节的创新性、科学性和实践性。

The 6^th annual Diphereline IVF training campus in 2010 is designed to highlight ＂innovative, scientific and practical controlled ovarian stimulation＂. The controlled ovarian stimulation （COS） with pituitary down regulation protocol has helped to achieved more high-quality oocytes and subsequently a higher preg- nancy rate. Down regulation is critical in COS, and the commonly used protocol is gonadotropin releasing hormon-agonist （GnRH-a） down regulation. However, with the high dose of GnRH-a, the pituitary is deeply suppressed, which in turn results in the increased gonadotropin dose and many more poor responders. The lower doses of GnRH-a have been studied and the minimum effective dose is to be determined. COS in China has developed from simple imitation to innovation and many effective protocols developed, including mild stimulation protocol, with excellent outcomes. A low-dose diphereline long protocol down regulation initiated at mid-luteal phase （0.05 mg daily, for over 14 d） has been widely used in many assisted reproduction centers and achieved a good pregnancy rate in 4 consecutive years. Other similar pro- tocols have also achieved comparable results. A desired down regulation protocol in COS is expected to sufficiently suppress pituitary and decrease the dose of gonadotropin as well. A low-dose slowly-releasing diphereline protocol, with effective synchro- nization with LH surge of normal menstrual cycle, is promising. For the poor responders, the aged, or those with repeated implantation failure, down regulation with even lower dose of GnRH-a is suggested to avoid over-suppression of pituitary, and clomiphene is administered at the late follicular phase to prevent premature LH surge. Cryopreservation of embryos may improve the accumulated pregnancy rate.