Unit of Physiopathology of Human Reproduction and Gametes Cryopreservation, Department of Gynecology, Obstetric and Neonatolgy, University of Bari "Aldo Moro", Bari, Italy.
Reprod Biol Endocrinol. 2012 Apr 13;10:26. doi: 10.1186/1477-7827-10-26.
Several protocols are actually available for in Vitro Fertilization and Embryo Transfer. The review summarizes the main differences and the clinic characteristics of the protocols in use with GnRH agonists and GnRH antagonists by emphasizing the major outcomes and hormonal changes associated with each protocol. The majority of randomized clinical trials clearly shows that in "in Vitro" Fertilization and Embryo Transfer, the combination of exogenous Gonadotropin plus a Gonadotropin Releasing Hormone (GnRH) agonist, which is able to suppress pituitary FSH and LH secretion, is associated with increased pregnancy rate as compared with the use of gonadotropins without a GnRH agonist. Protocols with GnRH antagonists are effective in preventing a premature rise of LH and induce a shorter and more cost-effective ovarian stimulation compared to the long agonist protocol. However, a different synchronization of follicular recruitment and growth occurs with GnRH agonists than with GnRH antagonists. Future developments have to be focused on timing of the administration of GnRH antagonists, by giving a great attention to new strategies of stimulation in patients in which radio-chemotherapy cycles are needed.
有几种方案实际上可用于体外受精和胚胎移植。本综述通过强调与每种方案相关的主要结果和激素变化，总结了使用 GnRH 激动剂和 GnRH 拮抗剂的方案的主要差异和临床特点。大多数随机临床试验清楚地表明，在“体外”受精和胚胎移植中，外源性促性腺激素加促性腺激素释放激素 (GnRH) 激动剂的组合能够抑制垂体 FSH 和 LH 的分泌，与不使用 GnRH 激动剂的促性腺激素相比，妊娠率增加。与长激动剂方案相比，使用 GnRH 拮抗剂的方案可有效防止 LH 过早升高，并诱导更短且更具成本效益的卵巢刺激。然而，与 GnRH 拮抗剂相比， GnRH 激动剂会导致卵泡募集和生长的不同同步。未来的发展必须集中在 GnRH 拮抗剂的给药时间上，同时要特别关注需要进行放化疗周期的患者的新刺激策略。
