促性腺激素释放激素激动剂降调节激素替代治疗周期在冻融胚胎移植中的研究进展

doi:10.12280/gjszjk.20220236

摘要/Abstract

摘要：

冻融胚胎移植（frozen-thawed embryo transfer,FET）技术因具有提高累积妊娠率和降低卵巢过度刺激风险等优点被广泛应用于临床,移植胚胎质量、子宫内膜以及两者同步性是FET成功的关键因素。临床常见的子宫内膜准备方案包括自然周期、控制性卵巢刺激周期、激素替代治疗（hormone replacement treatment,HRT）周期以及降调节HRT周期。大多数妇女采用常规方案进行FET子宫内膜准备,但多囊卵巢综合征、子宫内膜异位症、子宫腺肌病、反复着床失败以及薄型子宫内膜等特殊人群,采用常规方案临床效果欠佳。垂体降调节方法是在促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist,GnRHa）垂体降调节基础上应用HRT准备子宫内膜,即降调节HRT周期较常规方案可有效改善上述特殊人群的妊娠结局。综述GnRHa降调节HRT周期的相关机制及其适宜人群。

关键词: 胚胎组织移植, 促性腺素释放激素, 激素替代疗法, 妊娠结局, 冻融胚胎移植, 子宫内膜准备方案, 降调节

Abstract:

Freeze-thawed embryo transfer (FET) has been widely used in clinical practice due to its advantages of the increasing cumulative pregnancy rate and the reducing risk of ovarian hyperstimulation. The quality of transplanted embryos, endometrium and their synchronization are the key factors of FET success. The common clinical schemes of endometrial preparation include natural cycle, controlled ovarian stimulation, hormone replacement treatment (HRT) and downregulation HRT. For the most women, the above conventional schemes can be used for FET endometrial preparation. For special patients such as the patients with polycystic ovary syndrome, endometriosis, adenomyosis, recurrent implantation failure and thin endometrium, the clinical effect of conventional endometrial preparation scheme is poor. The pituitary downregulation method is based on the GnRHa pituitary downregulation, and hormone replacement therapy is applied to prepare the endometrium, suggesting that the downregulated HRT cycle can effectively improve the pregnancy outcome of the above special population compared with the conventional endometrial preparation scheme. This paper reviews the related mechanisms of GnRHa down regulation of HRT cycle and its suitable population.

Key words: Fetal tissue transplantation, Gonadotropin-releasing hormone, Hormone replacement therapy, Pregnancy outcome, Frozen-thawed embryo transfer, Endometrial preparation scheme, Down-regulation

段霞, 王治鸿. 促性腺激素释放激素激动剂降调节激素替代治疗周期在冻融胚胎移植中的研究进展[J]. 国际生殖健康/计划生育, 2022, 41(5): 419-424.

DUAN Xia, WANG Zhi-hong. Research Progress of GnRHa Downregulated Hormone Replacement Treatment Cycle in Frozen-Thawed Embryo Transfer[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(5): 419-424.

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