血清性激素监测在促排卵周期中的作用  

Role of monitoring sex hormone in ovarian stimulation cycles

作　　者：牛志宏[1] 冯云 

机构地区：[1]上海交通大学医学院附属瑞金医院生殖医学中心,上海200025

出　　处：《生殖医学杂志》2013年第10期774-778,共5页Journal of Reproductive Medicine

摘　　要：控制性超排卵(COH)过程中,监测血清性激素的变化,对调整促排卵药物使用有重要作用。在早卵泡期,基础卵泡刺激素(bFSH)水平可预测体外受精(IVF)周期中卵巢的反应性及妊娠情况,而基础雌二醇(E_2)的升高较FSH升高能更早地反映卵巢储备功能减低。对于卵巢储备降低的患者(bFSH≥8 U/L),FSH/黄体生成素(LH)值预测卵巢反应性优于年龄和bFSH。在卵泡发育过程中存在LH窗,因此促排卵过程中,监测LH水平对于评估卵泡发育状况并及时调整药物方案有重要作用。促排卵早期E_2水平的变化能够提前预测卵巢反应。促排卵过程出现E_2值增加迅速,说明卵巢功能良好,当E_2值上升缓慢或者不上升,与卵巢反应差有关。而晚卵泡期血清孕酮(P)/E_2的比值比单纯研究E_2或P水平更具全面性。总之,在促排卵不同阶段检测性激素水平,结合卵泡发育情况,有助于共同指导促排卵方案的选择和促性腺激素(Gn)剂量的调整,获得最佳临床结局。Monitoring the changes of serum sex hormone has an important role in adjusting gonadotropin dose in the process of ovarian stimulation. In early follicular phase, bFSH value can be used to predict ovarian response and pregnancy outcomes in IVF cycles. Increased estradiol （E2） levels can reflect the decreased ovarian reserve earlier than elevated FSH levels. For patients with reduced ovarian reservation （bFSH≥8 U/L）,the value of FSH/LH in predicting the ovarian response is better than age and bFSH alone. There is a LH window during follicle development, so LH monitoring is important in the assessment of follicular development and adjustment of drug regimen timely. The elevated E2 levels can be used to predict ovarian response in advance in the early phase of ovarian stimulation. F4 level rapidly increasing indicates good ovarian function. On the contrary, E2 levels slowly raising or being stable, predicates poor ovarian response. However, the value of serum progesterone/E2 is more comprehensive than that of F4 or progesterone alone in late follicular phase. In conclusion, sex hormone assay in different stage of follicular development can help to select ovarian stimulation protocol and adjust gonadotropin dose, thus obtaining better clinical outcome.

关 键 词：性激素 控制性超排卵 妊娠 

分 类 号：R[医药卫生]