Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.
Endocr Rev. 2018 Oct 1;39(5):593-628. doi: 10.1210/er.2017-00236.
Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication "ovarian hyperstimulation syndrome" (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
不孕症影响六分之一的人口，越来越多的夫妇需要使用辅助生殖技术进行治疗。体外受精（IVF）治疗最常使用外源性 FSH 诱导卵泡生长和人绒毛膜促性腺激素（hCG）诱导卵母细胞最终成熟。然而，hCG 可能导致潜在危及生命的医源性并发症“卵巢过度刺激综合征”（OHSS），这可能导致健康妇女出现相当大的发病率，甚至罕见情况下导致死亡。在过去的二十年中，GnRH 激动剂（GnRHas）的使用开创了诱导卵母细胞最终成熟的更安全选择。最近，神经肽 kisspeptin，一种 GnRH 释放的下丘脑调节剂，已被研究作为卵母细胞成熟的新型诱导剂。用于诱导卵母细胞成熟的激素刺激对 IVF 治疗的成功（卵母细胞的回收和着床机会）和安全性（OHSS 风险）有重大影响。本综述旨在评估用于诱导 hCG、GnRHa、GnRHa 和 hCG 联合、重组 LH 或 kisspeptin 诱导卵母细胞最终成熟的激素方法的实验和临床数据。我们还检查了诱导卵母细胞最终成熟的诱导物在与卵泡生长参数和随后的卵母细胞回收间隔时间相关的时间的证据。总之，我们综述了用于诱导卵母细胞最终成熟的主要激素方法在临床实践中的疗效和安全性的数据，以及一些可能为未来提供新选择的新方法的数据。
