国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2012, Vol. 31 ›› Issue (5): 359-361.

• 热点问题 • 上一篇    下一篇

各种控制性卵巢刺激方案中诱发排卵的特点及运用

马文红,梁晓燕   

  1. 510655 广州，中山大学附属第六医院生殖医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2012-09-15 发布日期:2012-09-15

Characteristics of Trigger in the Different COS Protocols

MA Wen -hong，LIANG Xiao -yan   

  1. The SixthAffiliated Hospital of SUN Yat-sen University，Guangzhou 510655，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2012-09-15 Online:2012-09-15

PDF (PC)

7299

摘要： 自然月经周期中，黄体生成激素（LH）峰值对于卵子的成熟、排卵及黄体支持均有重要的作用。在控制性卵巢刺激（controlled ovarian stimulation，COS）周期中，临床上使用外源性药物达到与自然周期内源性LH峰值相同的效果；不同的COS 方案使体内的内分泌环境处于不同的状态，使用促性腺激素释放激素激动剂（GnRHa）降调节的周期中，垂体失去反应性，只能使用人绒毛膜促性腺激素（hCG ）或重组LH （rLH）诱发排卵( trigger) ；在拮抗剂方案中，高危患者使用GnRHa trigger 以降低卵巢过度刺激综合征（OHSS）的发生，但会明显降低活产率，增加流产率，需加强黄体支持以避免；在其他未使用垂体降调节的方案中，需根据具体的后续临床处理选择trigger 药物。

关键词: 促黄体激素, 绒毛膜促性腺激素, 促性腺素释放激素, 卵巢过度刺激综合征, 排卵诱导

Abstract: The midcycle surge of LH is absolutely required for the final maturation of oocyte，initiationof follicular rupture, and function of corpus luteum. Human chorionic gonadotrophin（hCG）and GnRH analogueare used for the final maturation of oocyte in assisted conception cycles. Which one is used usually depends onthe controlled ovarian stimulation （COS）protocol and different hypothalamus -pituitary condition. The timepoint, dose and medicine variety for trigger are dependent on the hypothalamus-pituitary condition, follicle andendometrium conditions of different protocols. hCG trigger induces better luteum function and high pregnancyrate, but it has higher OHSS rate. GnRH agonist causes low OHSS rate with the impaired pregnant andmiscarriage rate which could be improved by intensity luteum supply. GnRHa is not recommended to useroutinely asa trigger for final oocyte maturation in the fresh autologous cycles because of the lower ongoingpregnancy and live birth rates.

Key words: Luteinizing hormone, Chorionic gonadotropin, Gonadotropin -releasing hormone, Ovarian hyperstimulation syndrome, Ovulation induction