摘要
控制性促排卵的关键在于抑制早发黄体生成激素峰(LH峰)对卵泡发育的负面影响。传统的促性腺激素释放激素(GnRH)激动剂或拮抗剂方案存在高卵巢过度刺激综合征(OHSS)发生率、高成本及使用不方便等缺点。2015年匡延平教授首次提出了卵泡期高孕激素状态下促排卵(progestin primed ovarian stimulation,PPOS)方案,该方案利用口服外源性孕激素抑制LH峰联合人绝经期尿促性腺激素(hMG)促排卵,已被证实在各种卵巢反应的人群中均能有效抑制早发LH峰,获得高质量的胚胎及满意的临床结局。目前临床应用于PPOS方案的孕酮类药物有醋酸甲羟孕酮、安琪坦及地屈孕酮。作为一种新兴的促排卵方案,其安全性也值得关注。现将该方案作用机制、适用人群、不同孕激素类药物使用效果、对卵母细胞及胚胎质量影响及子代出生安全性进行综述。
It is essential to block the adverse effects of premature LH surge on developmental oocyte in the process of the controlled ovulation stimulation. The traditional protocols of ovulation induction, such as gonadotropin-releasing hormone agonist and antagonist, have some disadvantages of increasing incidence of ovarian hyperstimulation syndrome, high cost and inconvenience. In 2015, Professor Kuang YP proposed the progestin primed ovarian stimulation protocol(PPOS), in which exogenous progesterone was used to inhibit LH peak, and to combine with human menopausal urinary gonadotropin(hMG) to stimulate ovulation. PPOS protocol had been proved to be effective in inhibiting premature LH peak, obtaining good quality embryos and satisfactory clinical outcomes in women with all kinds of ovarian reactions. At present, progesterone drugs used in PPOS protocol include medroxyproges acetate, utrogestan and dydrogesterone. It is also necessary to concern the security of PPOS protocol. We reviewed the mechanism of PPOS protocol, the application population, the effeciency of different progesterone drugs, the effects on the quantity and quality of oocytes retrieved and the clinical outcomes,as well as the safety of newborn.
作者
于潇
麻婷
张学红(审校)
YU Xiao;MA Ting;ZHANG Xue-hong(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,China;Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University,Key Laboratory for Reproductive Medicine and Embryo of Gansu Province,Lanzhou 730000,China)
出处
《国际生殖健康／计划生育杂志》
CAS
2019年第6期489-492,共4页
Journal of International Reproductive Health/Family Planning
基金
甘肃省科技重大专项（092NKDA009）
甘肃省自然科学基金（18JR3RA338）
关键词
卵泡期
排卵诱导
卵母细胞
胚胎发育
孕酮
Follicular phase
Ovulation induction
Oocytes
Embryonic development
Progesterone
