Emperaire J C
Institut R. B. Greenblatt, Bordeaux.
Contracept Fertil Sex. 1994 Jul-Aug;22(7-8):459-67.
Ovulation has exclusively been triggered with Human Chorionic Gonadotropin (hCG) since the earlier times of follicular stimulation with Pregnant Mare Serum Gonadotropins (PMSG). hCG was chosen in regard of its LH-like effect, when isolated or purified human LH was not available. hCG, however, is not the physiologic hormone for ovulation triggering and shows many discrepancies in pharmacokinetics and bio-availability with LH, accounting for the permanent risk for ovarian hyperstimulation syndrome (OHSS) following hCG administration. Human recombinant LH should become available in the coming years, but it is at present possible to trigger ovulation in hMG--stimulated patients with their own pituitary LH, using a short-acting GnRH agonist. Literature shows that this method of triggering ovulation in in vitro fertilization (IVF) cycles as well as in non IVF cycles results in a satisfactory ovulatory process and pregnancy rates comparable to those observed following hCG administration. More over, triggering ovulation with endogenous LH considerably reduces the risks for OHSS, and perhaps for multiple pregnancies. Optimum posology for each GnRH agonist available remains to be evaluated to minimize the occurrence of short luteal phases following ovulation triggering with endogenous LH.
自从早期使用孕马血清促性腺激素（PMSG）进行卵泡刺激以来，一直仅使用人绒毛膜促性腺激素（hCG）来触发排卵。在无法获得分离或纯化的人促黄体生成素（LH）时，由于hCG具有类似LH的作用，所以选择了hCG。然而，hCG并非触发排卵的生理性激素，并且在药代动力学和生物利用度方面与LH存在许多差异，这也是hCG给药后发生卵巢过度刺激综合征（OHSS）的长期风险所在。重组人LH有望在未来几年上市，但目前对于接受人绝经期促性腺激素（hMG）刺激的患者，可以使用短效促性腺激素释放激素（GnRH）激动剂，利用其自身垂体分泌的LH来触发排卵。文献表明，这种在体外受精（IVF）周期以及非IVF周期中触发排卵的方法，会产生令人满意的排卵过程，且妊娠率与hCG给药后的妊娠率相当。此外，使用内源性LH触发排卵可显著降低OHSS的风险，或许还能降低多胎妊娠的风险。为了尽量减少内源性LH触发排卵后出现黄体期过短的情况，每种可用GnRH激动剂的最佳剂量方案仍有待评估。
