Nardo Luciano G, Sallam Hassan N
Department of Reproductive Medicine, St Mary's Hospital, Manchester and Division of Human Development, University of Manchester, UK.
Reprod Biomed Online. 2006 Jul;13(1):47-57. doi: 10.1016/s1472-6483(10)62015-9.
Implantation failure has been questioned for many cases of recurrent miscarriage and unsuccessful assisted reproduction. The exact cause of implantation failure is not known, but luteal phase defect is encountered in many of these cases. Consequently, women with recurrent miscarriages have been treated with progesterone supplementation with various degrees of success, and a recent meta-analysis has shown trends for improved live birth rates in those women. Progesterone probably acts as an immunological suppressant blocking T-helper (Th)1 activity and inducing release of Th2 cytokines. Numerous studies have confirmed that ovarian stimulation used in assisted reproduction is associated with luteal phase insufficiency, even when gonadotrophin-releasing hormone antagonists are used. In those patients, advanced endometrial histological maturity and a decrease in the concentration of cytoplasmic progesterone receptors are observed. Progesterone supplementation results in a trend towards improved ongoing and clinical pregnancy rates, except in patients treated with human menopausal gonadotrophin-only regimens, in whom ongoing pregnancy rates increase significantly. More randomized controlled trials are needed to increase the power of the currently available meta-analyses to further evaluate progesterone supplementation in both conditions.
对于许多复发性流产和辅助生殖失败的病例，着床失败一直备受质疑。着床失败的确切原因尚不清楚，但在许多此类病例中会出现黄体期缺陷。因此，复发性流产的女性接受了不同程度成功的孕激素补充治疗，最近的一项荟萃分析显示，这些女性的活产率有提高的趋势。孕激素可能作为一种免疫抑制剂，阻断辅助性T（Th）1细胞的活性并诱导Th2细胞因子的释放。大量研究证实，辅助生殖中使用的卵巢刺激与黄体期不足有关，即使使用促性腺激素释放激素拮抗剂也是如此。在这些患者中，观察到子宫内膜组织学成熟度提前以及细胞质孕激素受体浓度降低。除了仅接受人绝经期促性腺激素治疗方案的患者，孕激素补充治疗会使持续妊娠率和临床妊娠率有提高的趋势，而在这些患者中，持续妊娠率显著增加。需要更多的随机对照试验来增强当前可用荟萃分析的效力，以进一步评估这两种情况下的孕激素补充治疗。
