New Progress in Drug Pretreatment in Patients with Premature Ovarian Insufficiency

doi:10.12280/gjszjk.20200315

Abstract

Abstract:

Premature ovarian insufficiency (POI) is a heterogeneous disease that seriously affects the physical and mental health of women during childbearing period. However, the pathogenesis of POI is still unknown. For patients with POI, there is no effective means to prevent and/or restore their normal ovarian reserve. For those POI patients with fertility needs, the timely assisted reproductive treatment can improve their pregnancy rate and live birth rate. Individual fertility assessment of POI patients before assisted reproductive therapy, using a variety of pretreatment regimens, can effectively improve the poor ovarian response (POR), increase the success rate of assisted reproduction and improve pregnancy outcome. This article reviewed the progress in the pretreatment with assisted reproductive drugs in POI patients, including hormonal drugs, antioxidant stress agents, immunomodulators, anticoagulants and metabolic regulators, in order to provide reference for the selection of individual treatment protocols. It is true that the pretreatment with assisted reproductive drugs in patients with POI is very important for improving the pregnancy outcome.

Key words: Primary ovarian insufficiency, Reproductive techniques, assisted, Transplantation conditioning, Antioxidants, Immunomodulation

SHUAI Ling, DIAO Rui-ying, WU Sha, ZHONG Mei, WANG Li-ping. New Progress in Drug Pretreatment in Patients with Premature Ovarian Insufficiency[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(1): 53-59.

Figures/Tables 3

References 35

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促排卵药	分泌或合成	半衰期	作用	伴随效应	对垂体反应	不良反应
GnRH	下丘脑分泌	正常	与GnRHR结合,促进LH和FSH释放	正常	正常	正常
GnRHa	人工合成	延长	短期与GnRHR结合,促进LH和FSH释放;持续应用抑制LH和FSH释放	有点火效应	起效慢（2~3周）; 恢复慢（2~3周）	OHSS多
GnRH_A	人工合成	延长	完全阻断内源性GnRH作用,迅速降低血清FSH、LH	无点火效应	起效快（1 h后）; 恢复快（48 h后）	OHSS少; 快速抑制LH峰

促排卵药	分泌或合成	半衰期	作用	伴随效应	对垂体反应	不良反应
GnRH	下丘脑分泌	正常	与GnRHR结合,促进LH和FSH释放	正常	正常	正常
GnRHa	人工合成	延长	短期与GnRHR结合,促进LH和FSH释放;持续应用抑制LH和FSH释放	有点火效应	起效慢（2~3周）; 恢复慢（2~3周）	OHSS多
GnRH_A	人工合成	延长	完全阻断内源性GnRH作用,迅速降低血清FSH、LH	无点火效应	起效快（1 h后）; 恢复快（48 h后）	OHSS少; 快速抑制LH峰

预处理方案	适用亚群	优点	缺点
DHEA	低DHEA患者	有效性确切,不良反应相对较小,成本低	雄激素相关不良反应
COCP	获卵数少的患者	不良反应小,成本低	有效性有待证实
GnRH类似物	短期有生育需求的患者	技术成熟,疗效确切	OHSS等
GH	GHD患者	有效性较确切	费用昂贵
r-LH	低LH或降调过深者	不良反应较小	有效性有待证实
CC和LTZ	降调过深者	成本低	药物安全性及有效性有待证实
抗氧化剂	高龄等	无明显不良反应	有效性有待证实
免疫调节剂	免疫性POI或合并自身免疫性疾病、具有RSA或反复种植失败病史的患者	潜在性,预防胚胎丢失	免疫抑制剂相关不良反应
抗凝剂	合并APS等血栓性疾病、具有RSA或反复种植失败病史的患者	潜在性,预防血栓和胚胎丢失	出血风险
代谢调节剂	代谢紊乱者	潜在性	有效性有待证实

预处理方案	适用亚群	优点	缺点
DHEA	低DHEA患者	有效性确切,不良反应相对较小,成本低	雄激素相关不良反应
COCP	获卵数少的患者	不良反应小,成本低	有效性有待证实
GnRH类似物	短期有生育需求的患者	技术成熟,疗效确切	OHSS等
GH	GHD患者	有效性较确切	费用昂贵
r-LH	低LH或降调过深者	不良反应较小	有效性有待证实
CC和LTZ	降调过深者	成本低	药物安全性及有效性有待证实
抗氧化剂	高龄等	无明显不良反应	有效性有待证实
免疫调节剂	免疫性POI或合并自身免疫性疾病、具有RSA或反复种植失败病史的患者	潜在性,预防胚胎丢失	免疫抑制剂相关不良反应
抗凝剂	合并APS等血栓性疾病、具有RSA或反复种植失败病史的患者	潜在性,预防血栓和胚胎丢失	出血风险
代谢调节剂	代谢紊乱者	潜在性	有效性有待证实