降调节对高龄低储备导致的低反应患者是否合适

摘要

高龄女性因卵巢储备下降,伴随对外源性促性腺激素(Gn)反应性下降,一直是辅助生殖助孕中的难点.常规垂体去敏感“降调节”作用优势在于有利于卵泡同步性及改善子宫内膜容受性,但在高龄患者中容易出现下丘脑轴的过度抑制,需增加促性腺激素(Gn)使用的时间和剂量,且结果常不理想.因此,对于高龄低储备导致的低反应患者是否使用降调节,以及如何掌控降调尺度,选择合适的促性腺激素释放激素激动剂(GnRH-a)降调方案、降调剂量和时间、以及Gn剂量和种类等需要综合把控,同时兼顾经济效益,这是临床医生面临的挑战.%Female ovarian reserve declines gradually with age.The elder women always accompany with low ovary response to stimulation in IVF cycles.By inducing hypophyseal desensitization,long GnRH agonist protocols prevent premature ovulation and luteinization,and significantly reduce the cycle cancellation rate compared with the cycles without down regulation.However,down regulation can lead to the excessive pituitary suppression.A higher overall dose of gonadotrophins and a longer duration of stimulation are often required for achieving a better ovarian response in the elder women.Therefore,whether using the down-regulation regimen in low-response patients,and how to adjust dose and duration of down-regulation regimen,and choose the type and dose of Gn,as well as account the economic benefits,are the challenge for the clinicians.