Tarlatzis B C, Fauser B C, Kolibianakis E M, Diedrich K, Rombauts L, Devroey P
Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Nea Efkarpia Peripheral Road, Thessaloniki 54603, Greece.
Hum Reprod Update. 2006 Jul-Aug;12(4):333-40. doi: 10.1093/humupd/dml001. Epub 2006 Mar 27.
The present review describes, on the basis of the currently available evidence, the consensus reached by a group of experts on the use of gonadotropin-releasing hormone (GnRH) antagonists in ovarian stimulation for IVF. The single or multiple low-dose administration of GnRH antagonist during the late-follicular phase effectively prevents a premature rise in serum luteinizing hormone (LH) levels in most women. Although controversy remains, most comparative studies suggest a slight, not significant reduction in the probability of pregnancy after IVF using GnRH antagonist versus GnRH agonist co-treatment. Published meta-analyses suggest that this slight difference in pregnancy rates is not attributed to chance. Further studies applying varying treatment regimens and outcome measures are required. Data are not in favour of a need to modify the starting dose of gonadotropins. Data are not in favour of increasing gonadotropin dose at GnRH antagonist initiation. The addition of LH from the initiation of ovarian stimulation or from GnRH antagonist administration does not appear to be necessary. Replacement of human chorionic gonadotropin (HCG) by GnRH agonist for triggering final oocyte maturation is associated with a lower probability of pregnancy. The optimal timing for HCG administration needs to be explored further. GnRH antagonist initiation on day 6 of stimulation appears to be superior to flexible initiation by a follicle of 14-16 mm, although earlier GnRH antagonist administration is worth further evaluation. Luteal phase supplementation in GnRH antagonist protocols remains mandatory in IVF. Effects of GnRH antagonist co-treatment on the incidence of ovarian hyperstimulation syndrome remains uncertain, although a trend is present in favour of the GnRH antagonists. The role of GnRH antagonists in ovarian stimulation for IVF appears to be promising, although many questions regarding preferred dose regimens and effects on clinical outcomes remain.
本综述基于目前可得的证据，描述了一组专家就促性腺激素释放激素（GnRH）拮抗剂在体外受精（IVF）卵巢刺激中的应用达成的共识。在卵泡晚期单次或多次低剂量给予GnRH拮抗剂可有效防止大多数女性血清促黄体生成素（LH）水平过早升高。尽管仍存在争议，但大多数比较研究表明，与GnRH激动剂联合治疗相比，使用GnRH拮抗剂进行IVF后妊娠概率略有降低，但差异不显著。已发表的荟萃分析表明，妊娠率的这种细微差异并非偶然。需要进一步开展应用不同治疗方案和结局指标的研究。现有数据不支持需要调整促性腺激素的起始剂量。现有数据不支持在开始使用GnRH拮抗剂时增加促性腺激素剂量。从卵巢刺激开始或从给予GnRH拮抗剂时起添加LH似乎没有必要。用GnRH激动剂替代人绒毛膜促性腺激素（HCG）触发最终卵母细胞成熟与较低的妊娠概率相关。HCG给药的最佳时机需要进一步探索。在刺激第6天开始使用GnRH拮抗剂似乎优于根据14 - 16mm卵泡灵活开始使用，不过更早开始使用GnRH拮抗剂值得进一步评估。在IVF中，GnRH拮抗剂方案的黄体期补充仍然是必需的。GnRH拮抗剂联合治疗对卵巢过度刺激综合征发生率的影响仍不确定，尽管有迹象表明GnRH拮抗剂有优势。GnRH拮抗剂在IVF卵巢刺激中的作用似乎很有前景，尽管关于最佳剂量方案及其对临床结局的影响仍有许多问题。
