促性腺激素释放激素拮抗剂在辅助生殖技术临床应用中的研究进展

Clinical Application of Gn RH Antagonist in Assisted Reproductive Technology

在辅助生殖技术(ART)中控制性卵巢刺激主要有3个目的:抑制垂体活动,刺激多卵泡生长和诱导排卵。作为传统促性腺激素释放激素激动剂(Gn RHa)的竞争对手,Gn RH拮抗剂(Gn RHA)在控制性卵巢刺激过程中抑制黄体生成激素(LH)峰作用更迅速,无Gn RHa相关的"骤然作用"和长时间垂体降调节效应,使促性腺激素(Gn)用量减少,治疗周期缩短,更有效地降低卵巢过度刺激综合征(OHSS)的发生。近年来Gn RHA已广泛用于各类不孕患者的控制性超促排卵(COH)过程中,尤其对特定不孕人群(卵巢低反应、高反应人群)具有一定的优势。然而拮抗剂方案作为一种不断改进中的新兴方案,能否取代传统激动剂长方案成为ART常规促排卵方案,仍需不断探索、总结及优化。

Three main purposes of the controlled ovarian stimulation(COS)in assisted reproductive technology(ART)were:to inhibit pituitary activity,to stimulate follicular growth and to induce ovulation.gonadotropin-releasing hormone antagonist(GnRHA)as a competitor of traditional GnRH agonist(GnRHa)inhibits the luteinizing hormone(LH)peak more rapidly,and GnRHA has no GnRHa-related"sudden action"and longterm effect of pituitary down-regulation.In the cycles with GnRHA,the dosage of gonadotropin(Gn)is reduced,the treatment time shorten,and the occurrence of ovarian hyperstimulation syndrome(OHSS)reduced more effectively.In recent years,GnRHA has been widely used in the controlled superovulation(COH)for various types of infertility patients,especially for those specific infertile patients(ovarian low responders,high responders).However,it is necessary to explore whether the new GnRHA protocol can replace the traditional GnRHa long-term protocol,or whether GnRHA protocol can be used as a routine COH protocol.Meanwhile,GnRHA protocol itself should be optimized in future.