摘要
促性腺激素释放激素拮抗剂(GnRH-A)在控制性超促排卵(COH)中被用于防止早现的内源性促黄体激素(LH)峰,与GnRH激动剂(GnRH-a)相比较,GnRH-A具有以下优点:没有低雌激素副作用、没有点火效应、起效快且作用可逆。2011年最新的循证医学证据显示,GnRH-A方案联合GnRH-a促发卵子最终成熟在获得了与GnRH-a方案类似的临床妊娠率的同时,可以显著降低卵巢过度刺激综合征(OHSS)的发病率,该方案值得进一步推广和优化。但由于GnRH-A导致体内LH水平显著低于生理水平,可能影响部分患者的卵泡发育,以及GnRH-a应用后对LH活性的抑制可能对黄体功能产生不利影响,LH活性的补充成为近来研究的热点。hCG可以结合体内的LH受体,且半衰期更长、亲和力更高,其效能是LH的6倍左右,hCG在拮抗剂方案中的应用值得进一步研究。
Gonadotrophin-releasing hormone antagonists（GnRH-A） can be used to prevent a luteinizing hormone（LH） surge during controlled ovarian hyperstimulation（COH） without the hypo-estrogenic side-effects,flare-up,or long down-regulation period associated with GnRH agonists（GnRH-a）.The updated Cochrane database in 2011 suggests that GnRH-A protocol is associated with a significant reduction in OHSS and comparable clinical outcomes.The future paramount aim should be to further improve the reproductive outcome by optimizing the details of the GnRH-A protocol.LH supplementation in GnRH-A protocol was studied widely in two aspects： 1） to improve the impaired follicle development due to low LH level induced by GnRH-A;2） to rescue the luteal phase deficiency after GnRH agonist triggering.The longer half-life and greater affinity for the LH/hCG receptor of hCG account for a potency ratio estimate of hCG-to-LH of around 1∶6.The application of hCG in GnRH-A protocol need further investigation.
出处
《生殖与避孕》
CAS
CSCD
2012年第9期599-602,共4页
Reproduction and Contraception
