Papanikolaou Evangelos G, Kolibianakis Efstratios, Devroey Paul
AZ-VUB, University Hospital, Dutch-speaking Brussels Free University Centre for Reproductive Medicine, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.
Expert Opin Emerg Drugs. 2005 May;10(2):425-40. doi: 10.1517/14728214.10.2.425.
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.
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。