The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 7th Floor, New York, NY, USA.
Best Pract Res Clin Obstet Gynaecol. 2012 Dec;26(6):777-88. doi: 10.1016/j.bpobgyn.2012.08.017. Epub 2012 Oct 9.
The efficacy of assisted reproductive technologies has improved significantly over the past decades. The main indications for in vitro fertilisation include tubal obstruction, severe male-factor infertility, severe endometriosis, ovulatory dysfunction, diminished ovarian reserve, and infertility of unexplained cause. In vitro fertilisation has also become an effective treatment option for couples wishing to undergo pre-implantation genetic diagnosis or screening, and for those wishing to cryopreserve their oocytes or embryos for preservation of fertility. The management of women in late reproductive age poses a major challenge; the optimum in vitro fertilisation treatment for poor responders remains elusive. The success of in vitro fertilisation treatment can be optimised by taking an individualised, patient-centered approach to controlled ovarian hyperstimulation. Key components involve selection of an appropriate controlled ovarian protocol, close-cycle monitoring, adjustment of gonadotropin dosage to avoid hyper-response, and individualised timing of human chorionic gonadotropin injection. Future directions of assisted reproductive technologies include development of non-invasive embryo selection methods, use of transcriptomics, proteomics, metabolomics, and time-lapse imaging technologies.
在过去的几十年中，辅助生殖技术的疗效有了显著提高。体外受精的主要适应证包括输卵管阻塞、严重的男性因素不育、严重的子宫内膜异位症、排卵功能障碍、卵巢储备功能降低以及不明原因的不孕。体外受精也已成为希望进行胚胎植入前遗传学诊断或筛查的夫妇以及希望冷冻其卵子或胚胎以保存生育能力的夫妇的有效治疗选择。高龄产妇的管理带来了重大挑战；对于反应不良者，最佳的体外受精治疗方法仍难以捉摸。通过对控制性卵巢过度刺激采取个体化、以患者为中心的方法，可以优化体外受精治疗的效果。关键组成部分包括选择适当的控制性卵巢方案、密切监测周期、调整促性腺激素剂量以避免过度反应，以及个体化的人绒毛膜促性腺激素注射时间。辅助生殖技术的未来发展方向包括开发非侵入性胚胎选择方法、使用转录组学、蛋白质组学、代谢组学和延时成像技术。
