Reproductive Medicine Center, University of Minnesota Medical School, Minneapolis, Minnesota 55454, USA.
Semin Reprod Med. 2010 Nov;28(6):468-74. doi: 10.1055/s-0030-1265673. Epub 2010 Nov 16.
The identification of patients at high risk for excessive responses to ovarian stimulation for in vitro fertilization and embryo transfer is essential in the tailoring of safe and effective treatment strategies. Known factors associated with increased sensitivity to gonadotropins include polycystic ovary syndrome, young age, prior ovarian hyperstimulation syndrome (OHSS), high baseline antral follicle count, and high baseline ovarian volume. Although several treatment strategies have been proposed for these patients, this report describes the experience using the dual suppression with gonadotropin step-down protocol. This protocol uses oral contraceptive pretreatment in combination with a long gonadotropin-releasing hormone agonist followed by a programmed step-down in gonadotropin dosing. Hormonal characteristics of dual suppression include an improved luteinizing hormone-to-follicle-stimulating hormone ratio and lower serum androgens, particularly dehydroepiandrosterone sulfate. Clinical characteristics of the protocol include a lower cancellation rate and favorable clinical and ongoing pregnancy rates per initiated cycle while mitigating the risk of OHSS.
识别对体外受精和胚胎移植的卵巢刺激反应过度的高危患者，对于制定安全有效的治疗策略至关重要。已知与对促性腺激素敏感性增加相关的因素包括多囊卵巢综合征、年龄较轻、既往卵巢过度刺激综合征 (OHSS)、基础窦卵泡计数高和基础卵巢体积大。尽管已经为这些患者提出了几种治疗策略，但本报告描述了使用双重抑制与促性腺激素剂量递减方案的经验。该方案使用口服避孕药预处理，联合使用长效促性腺激素释放激素激动剂，然后逐步减少促性腺激素剂量。双重抑制的激素特征包括改善黄体生成素与卵泡刺激素的比值和降低血清雄激素，特别是硫酸脱氢表雄酮。该方案的临床特征包括降低取消率和每个启动周期的有利临床和持续妊娠率，同时降低 OHSS 的风险。
