IVF/ICSI周期中拮抗剂方案扳机方式的选择

摘要

体外受精胞浆内单精子注射(IVF/ICSI)助孕治疗中,促性腺激素释放激素拮抗剂(GnRHA)方案因促性腺激素(Gn)刺激时间短、总费用低、方案灵活、患者易接受等优点,广泛应用于临床.人绒毛膜促性腺激素(hCG)通常用来促使卵泡最后的成熟和排出(又称hCG扳机),与黄体生成激素(LH)促卵泡排出效果相似,但hCG的半衰期更长,延长的黄素化效应增加了患者发生卵巢过度刺激综合征(OHSS)的风险.而促性腺激素释放激素激动剂(GnRHa)在促进卵泡最终成熟和排卵的同时(又称GnRHa扳机),又能降低OHSS的发病率,已在临床应用.但目前研究结果表明,GnRHa扳机最终会导致黄体功能的缺陷并影响临床妊娠率,增加流产率.GnRHa扳机后采用何种黄体期支持才能消除新鲜胚胎移植时的顾虑仍无定论.综述拮抗剂方案中GnRHa扳机的优势和存在的争议.%In IVF/ICSI cycle,GnRH antagonist (GnRHA) is widely used with the advantages of the short time of Gn stimulation,the low cost,the flexible solutions,which is easily accepted by patients.Human chorionic gonadotropin (hCG) is usually used to lead follicle final maturity and discharge (also called hCG trigger).Compared with the luteinizing hormone (LH),hCG has similar effect in follicle final maturity and discharge,and long halftime.However,the risk of ovarian hyperstimulation syndrome (OHSS) of hCG trigger is increased due to its long luteinization effect.However,gonadotropin-releasing hormone agonist (GnRHa) can not only promote follicle maturation and ovulation (also called GnRHa trigger) at the same time,but also reduce the incidence of OHSS.The present studies showed that GnRHa trigger could eventually lead to the defects of luteal function and influence the clinical pregnancy rate,and increase fresh embryo abortion.There is an inconclusion on what kind of the luteal support protocols after GnRHa trigger,to eliminate the concerns in the fresh embryo transfer.The advantages and disadvantages of GnRHa trigger in IVF/ICSI cycles were discussed in this article.