Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health Science, Copenhagen University, Copenhagen, Denmark; ARTs Biologics, Copenhagen, Denmark.
ARTs Biologics, Copenhagen, Denmark.
Reprod Biomed Online. 2014 May;28(5):552-9. doi: 10.1016/j.rbmo.2014.01.012. Epub 2014 Feb 5.
The human chorionic gonadotrophin (HCG) trigger used for final follicular maturation in connection with assisted reproduction treatment combines ovulation induction and early luteal-phase stimulation of the corpora lutea. The use of a gonadotrophin-releasing hormone agonist (GnRHa) for final follicular maturation has, however, for the first time allowed a separation of the ovulatory signal from the early luteal-phase support. This has generated new information that may improve the currently employed luteal-phase support. Thus, combined results from a number of randomized controlled trials using the GnRHa trigger suggest an association between the reproductive outcome after IVF treatment and the mid-luteal-phase serum progesterone concentration. It appears that a minimum mid-luteal progesterone threshold of approximately 80-100 nmol/l exists, which, when surpassed, results in reduced early pregnancy loss and an increased live birth rate. Further, the trade off between the HCG bolus and the subsequent risk of ovarian hyperstimulation syndrome has resulted in a trend to reduce the HCG bolus from 10,000 IU to 6500-5000 IU, which augments the HCG/LH deficiency during the early/mid-luteal phase. The mid-luteal HCG/LH shortage results in an altered progesterone profile, showing the highest concentration during the early luteal phase, contrasting with the mid-luteal peak seen in the natural menstrual cycle.
人类绒毛膜促性腺激素（HCG）触发用于辅助生殖治疗中的最终卵泡成熟，结合排卵诱导和早期黄体期黄体刺激。然而，使用促性腺激素释放激素激动剂（GnRHa）进行最终卵泡成熟首次允许将排卵信号与早期黄体期支持分离。这产生了新的信息，可能会改善目前采用的黄体期支持。因此，使用 GnRHa 触发的多项随机对照试验的综合结果表明，IVF 治疗后的生殖结局与中期黄体期血清孕激素浓度之间存在关联。似乎存在约 80-100 nmol/l 的最小中期黄体孕激素阈值，当超过该阈值时，会降低早期妊娠丢失率并提高活产率。此外，HCG 冲击与随后的卵巢过度刺激综合征风险之间的权衡，导致趋势是将 HCG 冲击从 10000IU 减少到 6500-5000IU，这增加了早期/中期黄体期的 HCG/LH 不足。中期黄体 HCG/LH 不足导致孕激素谱发生改变，在早期黄体期显示出最高浓度，与自然月经周期中所见的中期黄体峰形成对比。
