促性腺激素释放激素激动剂降调节方案对子宫内膜容受性的研究进展

Studies on GnRH agonist down-regulation protocols in regulation of endometrium receptivity

辅助生殖技术(ART)中,子宫内膜容受性(ER)是影响女性妊娠成功与否的重要因素。促性腺激素释放激素激动剂(GnRHa)在控制性卵巢刺激(COS)过程中得到广泛应用,GnRHa一方面解决了单纯促排卵导致的早发黄体生成激素(LH)峰造成卵子质量下降、周期取消率高的问题,另一方面能够通过调控激素及生物活性分子(雌、孕激素及其受体、整合素、转化生长因子等)的分泌、胞饮突的数量、HOXAl0等基因的表达影响ER,本文总结了GnRHa调节ER的机理,综述了不同的GnRHa降调节方案(GnRHa超长方案、GnRHa长方案、GnRHa短方案、GnRHa超短方案)对ER的影响,为临床上制定合理、科学的个体化GnRHa降调节方案提供参考。

Endometrium receptivity （ER） is a vital factor that affects women pregnancy m assisted reproductive techniques （ART）. Gonadotropin-releasing hormone agonist （GnRHa） has been widely used in controlled ovarian stimulation （COS）. GnRHa can not only prevent the premature luteinizing hormone （LH） surge-related worse follicles and higher cancellation rate caused by ovarian stimulation, but also affect the endometrium receptivity by regulating the secretion of hormones and bioactive molecules, such as estrogen and progesterone and their receptor, mtegrins and transforming growth factor （TGF）. Moreover, GnRHa can affect the endometrium receptivity by regulating the number of pinopodes and the expression of HOXA10 gene. In this review we summarized the mechanism of GnRHa in regulating endometrium receptivity briefly, and then reviewed different GnRHa down-regulation protocols （prolonged GnRHa protocol, long GnRHa protocol, short GnRHa protocol and ultra-short GnRHa protocol） m the regulation of endometrium receptivity, and finally help clinicists to design the rational and individual down-regulation protocol of GnRHa.