从超排周期所获成熟卵与不成熟卵比例的临床结局评议hCG诱发排卵最佳时机  

Optimal timing for human chorionic gonadotrophin administration from the point of view of the mature/immature oocytes ratio in controlled ovarian stimulation cycles

作　　者：李媛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院生殖医学中心,北京100020

出　　处：《生殖医学杂志》2012年第6期535-539,共5页Journal of Reproductive Medicine

摘　　要：自然周期中，内源性的黄体生成素（LH）峰为卵母细胞的成熟提供了最终的决定性刺激并介导了排卵，成熟的MⅡ卵母细胞得以排出。超促排卵周期中，使用尿源性或者重组的LH模拟LH峰已有多年的历史了，自启动开始，卵泡生长周期的长短便是由注射人类绒毛膜促性腺激素（hCG）的诱发排卵时间的选择来决定的，以达成获得十个左右成熟的具有良好发育潜能的卵母细胞的最终目的。In current controlled ovarian stimulation protocol, usage of recombination follicle stimulating hormone and gonadotropin releasing hormone analogue can to avert from the dominant follicle selection mechanism which results in single follicle maturation and ovulation. Because of this progress, multiple follicles can be recruited and develop simultaneously, so that more oocytes could be retrieved. Whereas because of the absence of endogenous luteinizing hormone surge, human Chorionic gonadotropin （hCG） has to be administrated to trigger final follicle maturation and induce ovulation. At the end of 7 follicular phase, there would be a series of ovulatary follicles with different diameters. It is tricky to determine optimal timing of hCG administration due to lack of synchronization. The current criteria for hCG administration is arbitrary and not uniformed. Each IVF program would draft their own criteria and determine the timing according to the characteristics of each cycle. And in particular cases, immature oocyte rate is unbearable because of inappropriate hCG trigger timing. So far the relationship between hCG administration and IVF/ICSI outcome remains uncertain. It is seemingly that, generally the ＂ trigger window＂ does exist and is not bitterly rigid. Based on our experience, oocytes with superior development capacity are aspirated from fairly large follicles with a diameter between 20 and 22 mm. At the same time, character of the patient, hormone levels and endometrium advancement should be considered. Because lack of knowledge of folliculogenesis and insufficiency of current monitoring methods, the exact timing of hCG administration could not be pinpointed. In the future, the development of perifollicular vascularization evaluation and serum/follicular anti-Mullerian hormone measurement will assist in identifying the optimal timing of hCG administration.

关 键 词：控制性卵巢刺激 人绒毛膜促性腺激素 卵母细胞发生 排卵 

分 类 号：R3[医药卫生—基础医学]