冻融胚胎移植中降调节激素替代周期的研究进展  

Research Progress of GnRHa Down-Regulation Protocols in Frozen-Thawed Embryo Transfer

作　　者：邢雅纯 凌秀凤(审校)[1] 苏雁[1] 赵纯[1] 张军强[1] XING Ya-chun;LING Xiu-feng;SU Yan;ZHAO Chun;ZHANG Jun-qiang(Reproductive Medicine Center,Women′s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)生殖医学中心,210004

出　　处：《国际生殖健康／计划生育杂志》2020年第3期233-237,共5页Journal of International Reproductive Health/Family Planning

基　　金：国家自然科学基金(81971386)。

摘　　要：冻融胚胎移植(frozen-thawed embryo transfer,FET)是一项应用广泛的辅助生殖技术,其成功妊娠的两个关键因素是发育潜能好的胚胎和准备良好的子宫内膜。临床常用的内膜准备方案包括自然周期(natural cycle,NC)、激素替代周期(hormone replacement treatment,HRT)、促排卵周期(controlled ovarian stimulation,COS)和降调节+HRT周期。降调节+HRT周期,又称降调节人工周期,是通过长效促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRHa)达到垂体降调节作用后,再添加外源性雌激素使子宫内膜增殖的一种内膜准备方案。GnRHa可以通过抑制下丘脑-垂体-卵巢轴使垂体降调节,避免不受控制的卵泡发育、血清黄体生成激素(LH)升高等问题,并通过能量代谢和免疫反应改善子宫内膜容受性。对于子宫内膜异位症(endometriosis,EMs)与子宫腺肌病(adenomyosis,AM)人群,多囊卵巢综合征(polycystic ovary syndrome,PCOS)人群、反复种植失败(recurrent implantation failure,RIF)人群、卵泡期血清孕酮水平升高人群以及薄型子宫内膜人群,GnRHa可改善子宫内膜容受性,促进胚胎种植,改善妊娠结局。The frozen-thawed embryo transfer(FET)has been a widely used technique in the past decades,in which two key factors of a successful pregnancy are the well-potential embryo the well-prepared endometrium.The protocols of endometrial preparation include natural cycle(NC),hormone replacement treatment cycle(HRT),controlled ovarian stimulation cycle(COS),and down-regulation plus HRT cycle.The down-regulation plus HRT cycle,also known as down-regulation artificial cycle,is a protocol of the endometrial preparation by adding exogenous estrogen after the pituitary down-regulation by using gonadotropin-releasing hormone agonist(GnRHa).GnRHa can regulate the pituitary gland by inhibiting the hypothalamic-pituitary-ovarian axis,avoid the uncontrolled follicular development and the elevated serum LH,and improve endometrial receptivity through energy metabolism and immune response.GnRHa can improve the pregnancy outcomes in people with endometriosis and adenomyosis,polycystic ovary syndrome,recurrent implantation failure,elevated progesterone in follicular phase,and thin endometrium.

关 键 词：胚胎移植 低温保存 促性腺素释放激素 减量调节 子宫内膜 

分 类 号：R714.8[医药卫生—妇产科学]