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21世纪的卵巢过度刺激综合征:促性腺激素释放激素激动剂扳机效应和亲吻素的作用

Ovarian hyperstimulation syndrome in the 21st century: the role of gonadotropin-releasing hormone agonist trigger and kisspeptin.

作者信息

Thomsen Lise, Humaidan Peter

机构信息

aThe Fertility Clinic, Skive Regional Hospital, Skive bFaculty of Health, Aarhus University, Aarhus, Denmark.

出版信息

Curr Opin Obstet Gynecol. 2015 Jun;27(3):210-4. doi: 10.1097/GCO.0000000000000170.

Abstract

PURPOSE OF REVIEW

Ovarian hyperstimulation syndrome (OHSS) complicates a considerable part of stimulated in-vitro fertilization (IVF) cycles and is a potential iatrogenic cause of death in otherwise healthy women undergoing fertility treatment. The triggering factor of OHSS is the widespread use of human chorionic gonadotropin (hCG) to induce final oocyte maturation. The aim of this review is to summarize different approaches available, using alternative triggering protocols such as gonadotropin-releasing hormone agonist (GnRHa) or kisspeptin for final oocyte maturation.

RECENT FINDINGS

According to the latest European Society of Human Reproduction and Embryology report, the incidence of OHSS ranges from 0.18 to 1.40% in European countries. However, OHSS is still subject to substantial underreporting. New triggering protocols using GnRHa have shown to be similar to the gold standard hCG-trigger with regard to the reproductive outcome, but with a significant decrease in - and almost elimination of - OHSS. Lately, promising results have been reported for the use of kisspeptin to induce final oocyte maturation. Although until now no study has been performed in an OHSS risk population, theoretically, the risk of OHSS development might be even further reduced after kisspeptin trigger.

SUMMARY

GnRHa trigger is currently the best tool we have to prevent OHSS and at the same time maintain good reproductive outcomes. Future research will explore the safety and efficacy of kisspeptin trigger.

摘要

综述目的

卵巢过度刺激综合征(OHSS)使相当一部分体外受精(IVF)促排卵周期变得复杂,并且是接受生育治疗的健康女性潜在的医源性死亡原因。OHSS的触发因素是广泛使用人绒毛膜促性腺激素(hCG)诱导卵母细胞最终成熟。本综述的目的是总结使用替代触发方案(如促性腺激素释放激素激动剂(GnRHa)或 kisspeptin)诱导卵母细胞最终成熟的不同可用方法。

最新发现

根据欧洲人类生殖与胚胎学会的最新报告,欧洲国家OHSS的发生率在0.18%至1.40%之间。然而,OHSS仍存在大量漏报情况。使用GnRHa的新触发方案在生殖结局方面已显示与金标准hCG触发相似,但OHSS的发生率显著降低且几乎消除。最近,有报道称使用kisspeptin诱导卵母细胞最终成熟取得了有前景的结果。尽管到目前为止尚未在OHSS风险人群中进行研究,但从理论上讲,kisspeptin触发后OHSS发生的风险可能会进一步降低。

总结

GnRHa触发目前是我们预防OHSS并同时维持良好生殖结局的最佳工具。未来的研究将探索kisspeptin触发的安全性和有效性。

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