类固醇激素预处理在辅助生殖技术中的应用进展

doi:10.12280/gjszjk.20200159

摘要/Abstract

摘要：

在卵巢控制性促排卵（COS）过程中,窦卵泡对卵泡刺激素（FSH）的敏感性和充分利用率以及窦卵泡的协调生长是对促排卵效果起决定性作用的两个重要因素。越来越多的证据表明,类固醇激素预处理（复方口服避孕药、人工合成的雌二醇和孕激素）有效抑制或减弱早发的黄体期FSH抬头,使上述两个因素均受到积极影响,这些预处理措施可能对助孕结局产生决定性作用。然而,在COS前常规进行复方口服避孕药预处理或单独使用雌激素或孕激素预处理是否会提高体外受精（IVF）妊娠率和活产率,目前尚缺乏共识。汇总近年来相关临床研究进展,综述复方口服避孕药、雌激素及孕激素预处理在不同类型患者和不同卵巢刺激方案中的应用及其对辅助生殖技术助孕结局的影响。

关键词: 排卵诱导, 性腺甾类激素, 避孕药, 口服, 复合, 雌激素类, 孕激素类, 促性腺素释放激素, 妊娠结局

Abstract:

Adequate availability and FSH sensitivity of ovarian antral follicles, and coordination of their growth during controlled ovarian stimulation (COS), are two important factors that play a decisive role in pregnancy outcome. Growing evidence indicates that steroid hormone pretreatments may positively improve both factors by inhibiting or weakening the early rise of FSH at luteal phase. However, there is a lack of consensus on whether the conventional pretreatment with combined oral contraceptive pills (COCP), estrogen or progestin alone before COS will increase the IVF pregnancy rate and live birth rate. This article summarizes the clinical research progress of related topics in recent years, including the application of COCP, estrogen and progesterone pretreatment in different types of patients and different ovarian stimulation protocols, and the impact of hormonal pretreatment on the outcomes of assisted reproduction technology.

Key words: Ovulation induction, Gonadal steroid hormones, Contraceptives, oral, combined, Estrogens, Progestins, Gonadotropin-releasing hormone, Pregnancy outcome

郭静, 李媛. 类固醇激素预处理在辅助生殖技术中的应用进展[J]. 国际生殖健康/计划生育, 2021, 40(1): 60-63.

GUO Jing, LI Yuan. The Application Progress of Steroid Hormone Pretreatment in Assisted Reproductive Technology[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(1): 60-63.

参考文献 23

[1]	Howie R, Kay V. Controlled ovarian stimulation for in-vitro fertilization[J]. Br J Hosp Med (Lond), 2018,79(4):194-199. doi: 10.12968/hmed.2018.79.4.194.
[2]	Abu-Musa A, Haahr T, Humaidan P. Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations[J]. Int J Mol Sci, 2020,21(6):2110. doi: 10.3390/ijms21062110.
[3]	Cohen BL, Katz M. Pituitary and ovarian function in women receiving hormonal contraception[J]. Contraception, 1979,20(5):475-487. doi: 10.1016/0010-7824(79)90053-2.
[4]	Gaspard UJ, Dubois M, Gillain D, et al. Ovarian function is effectively inhibited by a low-dose triphasic oral contraceptive containing ethinylestradiol and levonorgestrel[J]. Contraception, 1984,29(4):305-318. doi: 10.1016/0010-7824(84)90064-7.
[5]	Gonen Y, Jacobson W, Casper RF. Gonadotropin suppression with oral contraceptives before in vitro fertilization[J]. Fertil Steril, 1990,53(2):282-287. doi: 10.1016/s0015-0282(16)53282-8.
[6]	Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance[J]. Hum Reprod Update, 2016,22(6):687-708. doi: 10.1093/humupd/dmw025.
[7]	Song SY, Yang JB, Song MS, et al. Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: a meta-analysis[J]. Arch Gynecol Obstet, 2019,300(3):737-750. doi: 10.1007/s00404-019-05210-z.
[8]	Wei D, Shi Y, Li J, et al. Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome[J]. Hum Reprod, 2017,32(2):354-361. doi: 10.1093/humrep/dew325.
[9]	Xu Z, Meng L, Pan C, et al. Does oral contraceptives pretreatment affect the pregnancy outcome in polycystic ovary syndrome women undergoing ART with GnRH agonist protocol?[J]. Gynecol Endocrinol, 2019,35(2):124-127. doi: 10.1080/09513590.2018.1500535.
[10]	Xu L, Ding L, Jiang J, et al. Effects of oral contraceptive pretreatment on IVF outcomes in women following a GnRH agonist protocol[J]. Reprod Biomed Online, 2019,39(6):924-930. doi: 10.1016/j.rbmo.2019.08.002.
[11]	Montoya-Botero P, Martinez F, Rodríguez-Purata J, et al. The effect of type of oral contraceptive pill and duration of use on fresh and cumulative live birth rates in IVF/ICSI cycles[J]. Hum Reprod, 2020,35(4):826-836. doi: 10.1093/humrep/dez299.
[12]	Shahrokh Tehrani Nejad E, Bakhtiari Ghaleh F, Eslami B, et al. Comparison of pre-treatment with OCPs or estradiol valerate vs. no pre-treatment prior to GnRH antagonist used for IVF cycles: An RCT[J]. Int J Reprod Biomed(Yazd), 2018,16(8):535-540.
[13]	张丹, 张多多, 王增艳, 等. 口服避孕药预处理对使用GnRH拮抗剂方案正常反应人群结局影响的前瞻性队列研究[J]. 中国实用妇科与产科杂志, 2018,34(11):1277-1281. doi: 10.19538/j.fk2018110121.
[14]	Farquhar C, Rombauts L, Kremer JA, et al. Oral contraceptive pill, progestogen or oestrogen pretreatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques[J]. Cochrane Database Syst Rev, 2017,5:CD006109.doi: 10.1002/14651858.
[15]	Kim CH, Jeon GH, Cheon YP, et al. Comparison of GnRH antagonist protocol with or without oral contraceptive pill pretreatment and GnRH agonist low-dose long protocol in low responders undergoing IVF/intracytoplasmic sperm injection[J]. Fertil Steril, 2009,92(5):1758-1760. doi: 10.1016/j.fertnstert.2009.05.013.
[16]	Kim CH, You RM, Kang HJ, et al. GnRH antagonist multiple dose protocol with oral contraceptive pill pretreatment in poor responders undergoing IVF/ICSI[J]. Clin Exp Reprod Med, 2011,38(4):228-233. doi: 10.5653/cerm.2011.38.4.228.
[17]	郭钰英, 戴芳芳, 郑波, 等. 不同甾体激素预处理对高龄女性IVF/ICSI周期结局的影响[J]. 中国优生与遗传杂志, 2019,27(3):360-364. doi: 10.13404/j.cnki.cjbhh.2019.03.040.
[18]	Sefrioui O, Madkour A, Kaarouch I, et al. Luteal estradiol pretreatment of poor and normal responders during GnRH antagonist protocol[J]. Gynecol Endocrinol, 2019,35(12):1067-1071. doi: 10.1080/09513590.2019.1622086.
[19]	易思思, 梁新红, 丘映. GnRH拮抗剂方案中雌激素预处理与正常反应患者临床结局的Meta分析[J]. 生殖医学杂志, 2017,26(4):345-350. doi: 10.3969/j.issn.1004-3845.2017.04.011.
[20]	陈艳, 胡彩. 卵泡期雌激素预处理对卵巢低反应患者IVF-ET结局的影响[J]. 中国妇幼健康研究, 2018,29(1):104-107. doi: 10.3969/j.issn.1673-5293.2018.01.028.
[21]	Lee H, Choi HJ, Yang KM, et al. Efficacy of luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist priming protocol in poor responders undergoing in vitro fertilization[J]. Obstet Gynecol Sci, 2018,61(1):102-110. doi: 10.5468/ogs.2018.61.1.102.
[22]	李元. 地屈孕酮预处理可以增加拮抗剂方案中卵泡均匀性[D]. 中南大学, 2014.
[23]	孙林, 常惠, 于黎黎, 等. 地屈孕酮预处理在卵巢储备功能下降患者体外受精-胚胎移植中的应用[J]. 中国实用医药, 2017,12(4):8-11. doi: 10.14163/j.cnki.11-5547/r.2017.04.003.