进一步认识垂体降调节  

Progression in understanding pituitary down regulation

作　　者：何钻玉[1] 杨冬梓[1] 

机构地区：[1]中山大学孙逸仙纪念医院妇产科生殖中心,广州510120

出　　处：《生殖医学杂志》2013年第10期731-736,共6页Journal of Reproductive Medicine

摘　　要：控制性超排卵(COH)过程中使用促性腺激素释放激素激动剂(GnRH-a)进行垂体降调节可以有效地预防早发黄体生成素(LH)峰,降低了周期取消率,同时还可以改善卵泡发育的同步化,但垂体降调节也可能由于垂体抑制过度而出现促性腺激素(Gn)使用量增加、卵巢反应不良增加。因此适度地降调节对COH的顺利进行提供了保障。用于垂体降调节的GnRH-a分长效和短效两种剂型,不同的剂量和剂型的垂体抑制程度不同,保留的垂体反应性也不同。而GnRH-a是否通过调节卵巢旁分泌和自分泌影响卵泡的同步化发育尚未有定论。本文就垂体降调节的优缺点及降调节程度的研究发展进行总结。Pretreatment with gonadotrophin-releasing hormone agonist （GnRH-a） in patients undergoing controlled ovarian hyperstimulation （COH） for assisted reproduction has been widely used in IVF centres. The suppression of pituitary gonadotrophin secretion can prevent premature luteinizing hormone （LH） surge and follicle luteinization, and improve synchronization of follicular development. However,it has been reported that excessive pituitary down regulation by long-term use of GnRH-a has disadvantages of delayed or poor ovarian response and higher number of gonadotrophin ampoules used. Several studies have indicated that it may be benefit of partial pituitary desensitization. The aim of this article is to summarize the advantages and disadvantages of pituitary down-regulation which might not be suitable for some specific population,and to review the studies about optimum dose of GnRH-a which can prevent LH surge without excessive suppression of pituitary. Further study is needed to explore whether GnRH-a affects intra-ovarian paracrine or autocrine factors to improve follicular synchronization.

关 键 词：垂体降调节 卵泡发育同步化 控制性超排卵 

分 类 号：R[医药卫生]