不孕症合并生长激素缺乏的诊治

Diagnosis and treatment of infertility with growth hormone deficiency.

生长激素在调节生长发育和代谢中起着关键作用,在女性生殖方面亦有不可替代的作用。各种原因导致的生长激素绝对缺乏除影响生长发育外,还会对女性生殖功能,包括卵泡募集和发育、排卵和黄体功能、胚胎种植及妊娠维持等产生影响。值得注意的是,与年龄增长相关的后天性生长激素水平下降可能导致生长激素相对缺乏,从而影响多种生殖病理改变。虽然存在争议,但有证据表明,不孕症合并生长激素相对缺乏的女性在卵巢刺激期间使用生长激素可在一定程度上提高辅助生殖技术治疗的效率,包括卵母细胞数量、受精率、胚胎质量、胚胎种植率、妊娠率和活产率,特别对于卵巢低反应和反复植入失败的患者。因此,不孕症合并生长激素相对缺乏的临床诊断标准及治疗规范亟需进一步明确。

Growth hormone plays a key role in regu⁃lating growth,development and metabolism,and also has an irreplaceable role in female reproduction.Ab⁃solute growth hormone deficiency(GHD)caused by various reasons also affects female reproductive function,including follicular recruitment and development,ovulation and luteal function,embryo implantation and pregnancy maintenance.It is noteworthy that the agerelated GH decrease may lead to a relative GHD that affects multiple reproductive pathological changes.Although controversial,there is evidence that women with relative GHD during ovarian stimulation can im⁃prove the efficiency of assisted reproductive therapy,including oocyte number,fertilization rate,embryo quality,implantation rate,pregnancy rate and live birth rate,especially in patients with low ovarian response and repeated implantation failure,but it is still con⁃troversial.Therefore,the clinical diagnostic criteria and treatment standard of infertility patients with relative GHD need to be further clarified.