The Fertility Clinic, Skive Regional Hospital, Skive, Denmark. Faculty of Health, Aarhus University, Aarhus, Denmark. Faculty of Health, University of Southern Denmark, Odense, Denmark.
IVF Unit, Elisha Hospital, Haifa, Israel.
Curr Opin Obstet Gynecol. 2021 Jun 1;33(3):213-217. doi: 10.1097/GCO.0000000000000701.
GnRH agonist products are used extensively worldwide to trigger ovulation and final oocyte maturation in in vitro fertilization cycles. The purpose of this article is to outline possible causes for a suboptimal response to the GnRH agonist trigger.
Risk factors for such a suboptimal response include prolonged hormonal contraceptive use, previous GnRHa-induced pituitary downregulation, a hypogonadotropic/hypogonadal condition, patient error, environmental conditions that may damage the GnRHa product used, GnRH and luteinizing hormone (LH) receptors polymorphisms, low baseline LH and low endogenous serum LH levels on trigger day as well as low BMI. The induction of an adequate LH surge can be ascertained by an LH urine test 12 h post trigger.
In most cases, GnRHa trigger elicits effective LH+follicle stimulating hormone surges, resulting in mature, fertilizable oocytes. Clinical awareness to conditions that may predispose to a suboptimal response to the GnRHa trigger may prevent failed oocyte retrial.
目的：促性腺激素释放激素激动剂产品在全球范围内广泛用于体外受精周期中触发排卵和最终卵母细胞成熟。本文的目的是概述 GnRH 激动剂触发反应不佳的可能原因。
发现：这种反应不佳的风险因素包括长期使用激素避孕药、先前 GnRH 诱导的垂体下调、低促性腺激素/低性腺功能状态、患者错误、可能损害使用的 GnRH 产品的环境条件、GnRH 和黄体生成素 (LH) 受体多态性、低基础 LH 和触发日的低内源性血清 LH 水平以及低 BMI。LH 尿试验可在触发后 12 小时确定是否诱导出足够的 LH 峰。
总结：在大多数情况下，GnRHa 触发会引发有效的 LH+卵泡刺激素激增，从而产生成熟、可受精的卵子。对可能导致 GnRH 触发反应不佳的情况的临床认识可以防止卵母细胞重试失败。
