卵泡刺激素与高纯度尿促性腺激素联合方案在体外受精中有效性的评价

Evaluating the Efficacy of Mixed Protocol with FSH and Menopour in Women Undergoing in vitro Fertilization

在控制性促排卵(controlled ovarian stimulation,COS)中,促卵泡生成素(FSH)联合高纯度尿促性腺激素(HP-hMG)促排卵的理论基础是基于促黄体生成素(LH)具有协同FSH促进卵泡发育和卵子成熟的作用。COS通常采用促性腺激素释放激素激动剂(GnRH-a)或促性腺激素释放激素抑制剂(GnRH-A)抑制早发内源性LH峰,致内源性LH水平降低,尤其在卵泡发育中晚期随着颗粒细胞上LH受体增加,对生理性LH的需求也增加。因此,理论上COS中FSH促排卵同时配伍一定量的LH活性制剂(如:HP-hMG,商品名为贺美奇)可能有利于改善COS结局。但目前FSH联合hMG应用的报道并不多,从目前有限的数据显示FSH联合hMG的多样化配伍方案均可获得满意的临床结果,关键是需要针对每个个体制定个体化的COS方案。

Controlled ovarian stimulation（COS） protocols that use both hMG or HP-hMG and FSH known as ＂mixed protocols＂,are based on ＂two cells,two gonadotropins theory＂which suggests that synergistic interaction of FSH and LH is crucial for appropriate folliculogenesis and oocyte maturation.The GnRH agonist（GnRHa） or GnRH antagonist（GnRH-A） employed in COS to suppress premature LH surge can reduce LH concentration.Whether it is necessary to LH supplementation during COS has remained controversial.Ovarian stimulation in IVF is successfully performed by using hMG or FSH preparations alone.The impact on IVF outcome of the different gonadotropin preparations such as hMG and FSH has been widely debated.In an attempt to improve IVF outcome,a lot of clinicians have employed that combine HP-hMG and FSH,so-called ＂mixed protocols＂.Recently,it is reported that FSH or HP-hMG alone protocols and mixed protocols with the different ratios of FSH∶HP-hMG administered have shown equally effective.The key point is to assess characteristics of individual women in order to determine in advance of an IVF attempt which COS protocol will produce the highest take-home baby rate.