如何在临床实践中实现卵巢刺激的个性化。
How to personalize ovarian stimulation in clinical practice.
作者信息
Sighinolfi Giovanna, Grisendi Valentina, La Marca Antonio
机构信息
Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia and Clinica Eugin, Modena, Italy.
出版信息
J Turk Ger Gynecol Assoc. 2017 Sep 1;18(3):148-153. doi: 10.4274/jtgga.2017.0058.
Abstract
Controlled ovarian stimulation (COS) in in vitro fertilization (IVF) cycles is the starting point from which couple's prognosis depends. Individualization in follicle-stimulating hormone (FSH) starting dose and protocol used is based on ovarian response prediction, which depends on ovarian reserve. Anti-Müllerian hormone levels and the antral follicle count are considered the most accurate and reliable markers of ovarian reserve. A literature search was performed for studies that addressed the ability of ovarian reserve markers to predict poor and high ovarian response in assisted reproductive technology cycles. According to the predicted response to ovarian stimulation (poor- normal- or high- response), it is possible to counsel couples before treatment about the prognosis, and also to individualize ovarian stimulation protocols, choosing among GnRH-agonists or antagonists for endogenous FSH suppression, and the FSH starting dose in order to decrease the risk of cycle cancellation and ovarian hyperstimulation syndrome. In this review we discuss how to choose the best COS therapy, based on ovarian reserve markers, in order to enhance chances in IVF.
摘要
体外受精（IVF）周期中的控制性卵巢刺激（COS）是夫妻预后所依赖的起点。促卵泡激素（FSH）起始剂量和所用方案的个体化基于对卵巢反应的预测，而这又取决于卵巢储备。抗苗勒管激素水平和窦卵泡计数被认为是卵巢储备最准确和可靠的标志物。我们进行了文献检索，以查找探讨卵巢储备标志物预测辅助生殖技术周期中卵巢低反应和高反应能力的研究。根据预测的卵巢刺激反应（低反应 - 正常反应 - 或高反应），可以在治疗前向夫妻提供有关预后的咨询，并使卵巢刺激方案个体化，在内源性FSH抑制方面选择促性腺激素释放激素（GnRH）激动剂或拮抗剂，以及选择FSH起始剂量，以降低周期取消和卵巢过度刺激综合征的风险。在本综述中，我们讨论如何基于卵巢储备标志物选择最佳的COS治疗方法，以提高体外受精的成功率。
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