子宫内膜异位症合并不孕患者控制性促排卵方案的选择

Choice of controlled ovarian stimulation protocols for women with endometriosis-related infertility

子宫内膜异位症(EMS)是引起育龄女性不孕的重要因素之一,其原因与盆腔解剖结构改变、内分泌和免疫功能失调等有关。体外受精-胚胎移植(IVF-ET)技术是EMS合并不孕的有效助孕方法。促性腺激素释放激素激动剂(GnRH-a)超长方案是最常用的控制性促排卵方案,但该方案可能导致过度的垂体抑制,进而提高卵巢反应不良的风险。如何综合考量EMS不孕患者自身因素,针对不同情况选择个体化的GnRH-a降调节方案是临床面临的挑战。本文综述了EMS合并不孕患者应用不同控制性促排卵方案的IVF-ET结局,探讨个体化的控制性促排卵方案选择策略。

Endometriosis (EMS) is one of the important factors of female infertility. The possible causes of infertility include the abnormal pelvic anatomy, the decreased ovarian function and imbalance of immune function. The in vitro fertilization-embryo transfer (IVF-ET) is an effective method for EMS associated with infertility. Gonadotropin-releasing hormone agonists (GnRH-a) prolonged protocol is regarded as the most common treatment for patients with EMS-related infertility. However, long time pituitary suppression may lead to increase of total dosage of Gn used and the risk of poor ovarian response. How to consider the infertility factors of patients with EMS comprehensively and choose personalized GnRH-a protocols for different situations is a clinical challenge. In this review, we summarized the clinical outcomes of different pituitary down regulation protocols in women with EMS-related infertility undergoing IVF-ET and set up the individualized treatment strategy.