促排卵中卵泡刺激素的最大值  

The maximal dose of FSH in superovulation

作　　者：朱桂金[1] 徐蓓[1] 聂睿[1] 

机构地区：[1]华中科技大学附属同济医院妇产科生殖中心,武汉430030

出　　处：《生殖医学杂志》2010年第A01期22-25,共4页Journal of Reproductive Medicine

摘　　要：在促排卵过程中,卵泡的发育不仅取决于卵泡刺激素(FSH)的剂量,还取决于基础窦卵泡数,窦卵泡中颗粒细胞数量,颗粒细胞表面FSH受体的质量以及卵母细胞的质量。当FSH剂量达到阈值后,卵泡发育的关键就取决于窦卵泡数和卵泡发育的内在因素。窦卵泡在正常范围内,增加剂量可能增加获卵数,但并不增加妊娠率,因此促性腺激素(Gn)剂量只要超过需要卵泡数的阈值即可,一般建议为150～225 IU;而卵巢反应不良的患者,由于卵巢内能对FSH发生反应的小窦卵泡数减少,而且卵泡颗粒细胞和FSH受体数量下降,对FSH反应不敏感,因此增加剂量不能增加获卵数。系统综述、前瞻对照研究和回顾性研究结果均提示,FSH>300 IU不能增加获卵数和妊娠率,因此对卵巢反应不良患者建议的最大FSH剂量为300 IU/d。Follicular development in superovulation is not only dependent on FSH dose, but also the basal antral follicle count （AFC）, granulocyte number of antral follicles, FSH receptors on the granulocyte surface and the quality of oocytes. When FSH dose reaches threshold, AFC and the internal factors are the key to follicular development. If AFC is within the normal range, additional FSH dose may increase the number of oocytes retrieved, but not the pregnancy rate. So the dose of 150-225 IU is generally recommended. In the patients with poor response, the number of small antral follicles that are able to re spond to FSH decreases, and the reduction in granulocyte number and FSH receptors makes follicles insensitive to FSH. Therefore, the number of oocytes retrieved could not be increased through adding FSH dose. Systematic reviews, prospective controlled studies and retrospective studies demonstrated that, when more than 300 U of FSH administered, the number of oocytes retrieved and pregnancy rate did not increased. So, to the poor responder, the recommended maximal dose of FSH is 300 IU/d.

关 键 词：FSH 窦卵泡 卵巢反应不良 FSH受体 

分 类 号：R[医药卫生]