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辅助生殖领域的新兴药物。

Emerging drugs in assisted reproduction.

作者信息

Papanikolaou Evangelos G, Kolibianakis Efstratios, Devroey Paul

机构信息

AZ-VUB, University Hospital, Dutch-speaking Brussels Free University Centre for Reproductive Medicine, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.

出版信息

Expert Opin Emerg Drugs. 2005 May;10(2):425-40. doi: 10.1517/14728214.10.2.425.

DOI:10.1517/14728214.10.2.425
PMID:15934877
Abstract

Infertility affects approximately 15% of couples of reproductive age. In assisted reproductive technology (ART), medications play a crucial role in stimulating ovaries to produce several oocytes and prepare the endometrium to be receptive after replacing one or more embryos into the uterine cavity. The availability of recombinant human follicle stimulating hormone, luteinising hormone and human chorionic gonadotrophin; of gonadotrophin-releasing hormone (GnRH) agonists and antagonists; and of luteal supplementation with progesterone have allowed the tailoring of several stimulation schemes, which have enhanced the pregnancy outcome after ART treatment. However, the remaining risk of ovarian hyperstimulation syndrome, the still low implantation rates, the unacceptably high rates of multiple pregnancies and the daily parenteral administration of medications do not constitute the features of a patient-friendly procedure. Therefore, a number of molecules with gonadotrophin-like activity, inhibition of GnRH receptor ability, or endometrium receptivity enhancement properties are currently under active investigation. Orally bioactive therapeutic preparations, in particular, may revolutionize in vitro fertilisation (IVF) treatment in the near future. Nevertheless, the implementation of mild ovarian stimulation protocols with single embryo transfer policy and further development of oocyte in vitro maturation techniques may lead to a less drug orientated IVF treatment.

摘要

不孕症影响着约15%的育龄夫妇。在辅助生殖技术(ART)中,药物在刺激卵巢产生多个卵母细胞以及在将一个或多个胚胎植入子宫腔后使子宫内膜具备接受性方面发挥着关键作用。重组人促卵泡生成素、促黄体生成素和人绒毛膜促性腺激素;促性腺激素释放激素(GnRH)激动剂和拮抗剂;以及用黄体酮进行黄体期补充的可得性,使得能够制定多种刺激方案,从而提高了ART治疗后的妊娠结局。然而,卵巢过度刺激综合征的残留风险、仍然较低的着床率、高得令人难以接受的多胎妊娠率以及药物的每日肠胃外给药,都不构成一种对患者友好的治疗方法的特征。因此,目前正在积极研究一些具有促性腺激素样活性、抑制GnRH受体能力或增强子宫内膜接受性特性的分子。特别是口服生物活性治疗制剂可能在不久的将来给体外受精(IVF)治疗带来变革。尽管如此,实施轻度卵巢刺激方案并结合单胚胎移植策略以及进一步发展卵母细胞体外成熟技术,可能会使IVF治疗减少对药物的依赖。

相似文献

1
Emerging drugs in assisted reproduction.辅助生殖领域的新兴药物。
Expert Opin Emerg Drugs. 2005 May;10(2):425-40. doi: 10.1517/14728214.10.2.425.
2
A randomized controlled trial of increasing recombinant follicle-stimulating hormone after initiating a gonadotropin-releasing hormone antagonist for in vitro fertilization-embryo transfer.一项关于在启动促性腺激素释放激素拮抗剂后增加重组促卵泡激素用于体外受精-胚胎移植的随机对照试验。
Fertil Steril. 2006 Jul;86(1):58-63. doi: 10.1016/j.fertnstert.2005.12.040. Epub 2006 Jun 6.
3
GnRH antagonists in ovarian stimulation for IVF.用于体外受精卵巢刺激的促性腺激素释放激素拮抗剂
Hum Reprod Update. 2006 Jul-Aug;12(4):333-40. doi: 10.1093/humupd/dml001. Epub 2006 Mar 27.
4
Triggering ovulation with gonadotropin-releasing hormone agonists does not compromise embryo implantation rates.使用促性腺激素释放激素激动剂触发排卵不会影响胚胎着床率。
Fertil Steril. 2006 Dec;86(6):1682-7. doi: 10.1016/j.fertnstert.2006.05.049. Epub 2006 Oct 30.
5
Management of poor responders: can outcomes be improved with a novel gonadotropin-releasing hormone antagonist/letrozole protocol?低反应者的管理:一种新型促性腺激素释放激素拮抗剂/来曲唑方案能否改善结局?
Fertil Steril. 2008 Jan;89(1):151-6. doi: 10.1016/j.fertnstert.2007.02.013. Epub 2007 May 4.
6
[Coasting and ovarian stimulation protocols in high-responder patients undergoing assisted conception].[高反应患者辅助生殖中 coasting 与卵巢刺激方案]
Gynecol Obstet Fertil. 2005 Sep;33(9):703-12. doi: 10.1016/j.gyobfe.2005.06.011.
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GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity.促性腺激素释放激素激动剂与拮抗剂在卵巢刺激中的应用:子宫内膜容受性的作用
Fertil Steril. 2008 Oct;90(4):1294-6. doi: 10.1016/j.fertnstert.2007.10.022. Epub 2008 Jan 7.
8
Comparison of the efficacy and safety of a new recombinant human follicle-stimulating hormone (DA-3801) with follitropin-alpha (Gonal-F) in women undergoing controlled ovarian hyperstimulation for assisted reproductive technology.新型重组人促卵泡激素(DA-3801)与促卵泡素α(果纳芬)在接受辅助生殖技术控制性卵巢刺激的女性中疗效和安全性的比较
J Obstet Gynaecol Res. 2007 Jun;33(3):305-15. doi: 10.1111/j.1447-0756.2007.00529.x.
9
[In vitro oocyte maturation for safer treatment of infertility. The risk of ovarian overstimulation syndrome is minimized].
Lakartidningen. 2004 Nov 11;101(46):3665-8, 3671.
10
Mild ovarian stimulation for IVF.用于体外受精的轻度卵巢刺激。
Hum Reprod Update. 2009 Jan-Feb;15(1):13-29. doi: 10.1093/humupd/dmn056.

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