卵泡体外激活在早发性卵巢功能不全患者辅助生殖中的研究进展

In vitro follicle activation as a strategy for assisted reproduction in patients with premature ovarian insufficiency:research advances

早发性卵巢功能不全(premature ovarian insufficiency,POI)是指女性40岁之前出现卵巢功能减退,其病理基础是原始卵泡的耗竭或难以激活,这一类患者自然受孕率低,排卵诱导治疗效果不佳,目前尚无有效恢复卵巢功能的方法。针对卵泡的体外激活技术(in vitro activation,IVA)是指手术取出部分卵巢组织,在体外进行药物或物理干预来激活残存卵泡,然后回植体内,使之生长至能对促排卵治疗产生反应的阶段。再配合促排卵治疗,可获得用于体外受精-胚胎移植的成熟卵泡。迄今IVA技术尚不完善,但为POI患者的治疗提供了新的方向。本文总结了卵泡体外激活的原理,相关信号通路及各通路中的药物靶点,并对卵泡体外激活方案在POI患者中的应用与优化进行综述,为POI患者的诊疗提供依据。

Premature ovarian insufficiency(POI)refers to ovarian dysfunction in women before the age of 40 years,and its pathological basis is the depletion or difficult activation of primordial follicle.POI patients have a low natural conception rate and poor effect of ovulation induction therapy.At present,there is no effective method to restore ovarian function.In vitro activation(IVA)for follicles refers to surgical removal of part of the ovarian tissue,followed by drug or physical intervention in vitro,to activate the patient's remaining follicles.Finally,the tissue is rafted back to thesame ovary so that it can develop to thestage of responding to ovulation induction.In conjunction with the above procedure,ovulation induction can obtain mature follicles for in vitro fertilization and embryo transfer.IVA technology is an innovative therapeutic option for POI,and provides a new direction for the treatment of POI patients.This article summarizes the principle of IVA,related signaling pathways and drug targets in each pathway,and reviews the application and optimization of IVA protocols in POI patients,so as to provide a basis for the diagnosis and treatment of patients with POI.