Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Conceptum - Unidad de Fertilidad del Country, Bogotá, Colombia.
Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Faculty of Medicine and Pharmacy, Department of Surgical and Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium.
Best Pract Res Clin Endocrinol Metab. 2019 Feb;33(1):61-75. doi: 10.1016/j.beem.2018.09.003. Epub 2018 Sep 13.
Controlled ovarian hyperstimulation (COH) is a crucial part of assisted reproductive technologies (ART) that resulted in a substantial increase in pregnancy rates from in vitro fertilization (IVF). However, in spite of the apparent benefit of COH on an increase in the number of follicles and the number of oocytes retrieved, allowing for extended embryo culture and enabling the selection of the best quality embryo for transfer, several reports has shown that the supraphysiologic hormonal levels may indeed have a detrimental effect at the endometrial level. The current article revises the pathophysiological mechanisms through which ovarian stimulation may negatively affect endometrial receptivity. Also, the evidence is analyzed explaining how segmentation of IVF treatment may allow us to overcome the deleterious effects of hyperstimulation on endometrial receptivity. Deferred embryo transfer may be performed in a more physiologic uterine environment in a subsequent cycle, improve endometrial receptivity, decrease uterine contractility, diminishes the impact of premature luteinization and allow individualized stimulation according to the level of response.
控制性卵巢刺激（COH）是辅助生殖技术（ART）的重要组成部分，它使体外受精（IVF）的妊娠率显著提高。然而，尽管 COH 显然有利于增加卵泡数量和获取的卵子数量，从而延长胚胎培养时间，并选择最佳质量的胚胎进行移植，但有几项报告表明，超生理激素水平实际上可能对子宫内膜水平产生不利影响。本文回顾了卵巢刺激可能通过哪些病理生理机制对子宫内膜容受性产生负面影响。同时，也分析了如何通过将 IVF 治疗分段来克服超刺激对子宫内膜容受性的有害影响。在随后的周期中，可以在更接近生理的子宫环境中进行延迟胚胎移植，从而提高子宫内膜容受性，降低子宫收缩性，减少过早黄体化的影响，并根据反应水平进行个体化刺激。
