多囊卵巢综合征不孕患者超促排卵周期中的扳机方案研究进展

doi:10.12280/gjszjk.20200529

摘要/Abstract

摘要：

对于多囊卵巢综合征（polycystic ovarian syndrome,PCOS）不孕患者而言,需要更优的扳机方案,获得更多的优质成熟卵母细胞、更高的妊娠率和更好的周期结局,同时降低发生卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）和空卵泡综合征（empty follicle syndrome,EFS）的风险。制定扳机方案时需要考虑扳机的药物制剂、扳机时机等。人绒毛膜促性腺激素（human chorionic gonadotropin,hCG）扳机、促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist,GnRHa）扳机、亲吻素（Kisspeptin）扳机、双扳机、双重扳机等多种扳机方式在PCOS不孕患者中均有应用。梳理关于PCOS不孕患者超促排卵扳机方案的国内外文献,一方面对不同扳机方案的常用药物剂量和优缺点进行比较,另一方面对PCOS不孕患者选择扳机时机的标准进行总结,以期为临床制定PCOS扳机方案提供参考。

关键词: 多囊卵巢综合征, 体外受精, 排卵诱导, 扳机, 卵巢过度刺激综合征

Abstract:

For infertile patients with polycystic ovary syndrome (PCOS), it is necessary to optimize the trigger scheme so as to obtain more well-matured oocytes, higher pregnancy rate and better cycle outcomes, and to reduce the incidence of ovarian hyperstimulation syndrome (OHSS) and empty follicle syndrome (empty follicle syndrome, EFS) risk. When making the trigger plan, we need to consider the drug preparation and timing of trigger. Human chorionic gonadotropin (hCG) trigger, gonadotropin-releasing hormone agonist (GnRHa) trigger, Kisspeptin trigger, dual trigger, double trigger and other trigger methods have been used in PCOS infertile patients. Based on the literature review of the ovarian hyperstimulation trigger schemes for PCOS infertile patients, the trigger drugs, dosage, advantages and disadvantages of different trigger schemes were compared in this paper, including the standard of trigger timing. These comparisons provide us a useful reference for the clinical development of PCOS personalized trigger scheme.

Key words: Polycystic ovary syndrome, Fertilization in vitro, Ovulation induction, Trigger, Ovarian hyperstimulation syndrome

秦一鸣, 孔鑫靓, 张建伟. 多囊卵巢综合征不孕患者超促排卵周期中的扳机方案研究进展[J]. 国际生殖健康/计划生育, 2021, 40(3): 226-230.

QIN Yi-ming, KONG Xin-liang, ZHANG Jian-wei. Research Progress of Trigger Scheme in Ovarian Hyperstimulation Cycles in Infertile Women with Polycystic Ovary Syndrome[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(3): 226-230.

图/表 1

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制剂	规格	常用剂量	优点	缺点
u-hCG	500 IU,1 000 IU,2 000 IU, 3 000 IU,5 000 IU	2 000~10 000 IU	应用时间长;费用低廉	刺激VEGF表达,增加OHSS发生风险
r-hCG	250 μg∶0.5 mL	250 μg	制备方便;出现注射部位不良反应的概率较u-hCG更低	刺激VEGF表达,增加OHSS发生风险
GnRHa	0.1 mg,3.75 mg,15 mg	0.2 mg	正向调节FSH、LH;减少VEGF分泌,降低OHSS发生风险	易导致黄体功能不足
Kisspeptin	50 μg	尚未确定	诱导内源性FSH和LH释放,降低OHSS发生风险	黄体期损害较GnRHa更大;相关研究不足

制剂	规格	常用剂量	优点	缺点
u-hCG	500 IU,1 000 IU,2 000 IU, 3 000 IU,5 000 IU	2 000~10 000 IU	应用时间长;费用低廉	刺激VEGF表达,增加OHSS发生风险
r-hCG	250 μg∶0.5 mL	250 μg	制备方便;出现注射部位不良反应的概率较u-hCG更低	刺激VEGF表达,增加OHSS发生风险
GnRHa	0.1 mg,3.75 mg,15 mg	0.2 mg	正向调节FSH、LH;减少VEGF分泌,降低OHSS发生风险	易导致黄体功能不足
Kisspeptin	50 μg	尚未确定	诱导内源性FSH和LH释放,降低OHSS发生风险	黄体期损害较GnRHa更大;相关研究不足