拮抗剂方案中隐匿性LH峰一例诊治经验并文献复习

doi:10.12280/gjszjk.20220439

摘要/Abstract

摘要：

促性腺激素释放激素（gonadotropin releasing hormone，GnRH）拮抗剂方案作为目前临床常见的促排卵方案具有灵活、经济及安全性高的优点，但在实际应用中可因拮抗剂用药剂量不足或添加时机欠佳出现早发性黄体生成素（luteinizing hormone，LH）峰，最终影响妊娠结局。回顾1例在拮抗剂方案中出现隐匿性LH峰患者的临床资料，该患者在应用拮抗剂方案促排卵过程中出现了孕酮的上升，雌二醇的下降，提示隐匿性LH峰的发生，取卵时发现卵泡早排。第2周期改用黄体期长效长方案促排卵，期间未见内源性LH峰，最终成功获卵8枚。通过对相关文献进行复习，探讨在GnRH拮抗剂方案中发生隐匿性LH峰的诊断及预防方法。

关键词: 排卵诱导, 促性腺素释放激素, 双羟萘酸曲普瑞林, 促黄体激素, 隐匿性LH峰, GnRH拮抗剂方案

Abstract:

GnRH antagonist protocol, as a common clinical ovulation protocol, has the advantages of flexibility, economy and safety. However, the early-onset LH peak due to inadequate dosing or inappropriate timing of antagonist addition can ultimately affect pregnancy outcomes. We review the clinical data of a patient who developed an occult LH peak during the antagonist regimen. The patient showed an increased level of progesterone and a decreased level of estradiol during her ovulation with the antagonist regimen, suggesting the occurrence of an occult LH peak. She also had a premature ovulation during the oocyte retrieval procedures. In the second cycle, the long-lasting luteal phase regimen was used to effectively reduce the appearance of endogenous LH peak, and 8 eggs were successfully obtained. We also discuss the diagnosis and prevention of occult LH peak occurring in antagonist regimens in this paper.

Key words: Ovulation induction, Gonadotropin-releasing hormone, Triptorelin pamoate, Luteinizing hormone, Occult LH peak, GnRH antagonist protocol

王瑛欣, 张宁, 徐书凝. 拮抗剂方案中隐匿性LH峰一例诊治经验并文献复习[J]. 国际生殖健康/计划生育杂志, 2023, 42(1): 27-30.

WANG Ying-xin, ZHANG Ning, XU Shu-ning. Occult LH Peak in GnRH Antagonist Protocol: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(1): 27-30.

图/表 1

参考文献 21

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