课件：卵巢高反应人群的标准化管理.ppt

* 可与垂体GnRH结合，12h发挥flare up效应；持续应用2-3w则发生受体脱敏和内流达到受体降调的目的。所不同的是，拮抗剂完全通过与受体竞争性结合阻断内源性GnRH作用。 * GnRH激动剂降调方案抑制内源性FSH水平，使得给予外源性FSH时多个小卵泡同步被募集及发育。而拮抗剂方案并没有前期抑制垂体的过程，在黄体-卵泡转化期内源性FSH上升发挥募集作用。在给予外源性FSH时，本身卵泡生长就不在一个起跑线上，卵泡发育不均一性更明显。 * 去垂体效应与激动剂无差别，起效快(1-2h)，恢复快(48h) With respect to CPR, a GnRH antagonist protocol is similar to a GnRH agonist long protocol. However, for severe OHSS, a GnRH antagonist protocol is significantly better in PCOS patients. GnRH激动剂的使用阻滞了自发性LH峰，因此hCG被广泛用于代替LH促使卵泡破裂。 In GnRH antagonist protocol, the pituitary gland is not desensitized, so we can use agonist to trigger final oocyte maturation. Theoretically, it could reduce the risk of OHSS. 拮抗剂方案不存在GnRH受体的丢失，可逆性发挥抑制作用。 SmartArt X Slides - Charo * * The hCG curve shown here is that following 10,000 IU intramuscular injection. The LH curve shown is that following 0.5 mg of Lupron. The curve following 0.2 mg of Triptorelin was very similar. LH obviously has a much shorter half-life than does hCG.With the agonist trigger, LH is almost completely cleared by the morning of oocyte collection. With an hCG injection, termination of “LH activity” usually takes 10-12 days. 收之桑榆,失之东隅 * * * 无平台期，LH达峰值4h~12h 107~130IU/L，24h返回基线；FSH 8h达峰值19IU/L * 使用GnRH-a诱发排卵，GnRHa诱发的LH峰所引起的促黄体信号不足以维持正常的黄体功能 经典的黄体支持（给予孕酮、E2)是不足的 * * * * Ovarian volume, ascites, hematocrit, white blood cell count, serum estradiol and progesterone decreased significantly (P , 0.001) by the end of the monitoring period (Day 11 post-oocyte retrieval), indicating rapid resolution of the severe OHSS. * 来降低VEGF表达效应 0.5mg/d就能 * hCG日（或采卵日）给予0.5mg/d cabergoline for 7 days，8days，12days，3w 不等。 * * IVF临床结局比较（同济医院资料） 推迟启动组 对照组 P OHSS发生率 11.76% 19.94% ＜0.05 周期取消率 18.9% 26.19% ＜0.05 采卵周期临床妊娠率 41.82% 34.38% ＜0.05 移植周期临床妊娠率 51.56% 46.57% ＜0.05 减少hCG 剂量 与10000IU相比，5000IU hCG能有效诱发排卵,不影响妊娠结局 Fertil Steril 2004;82:841–6 更低hCG有效剂量的报道：21 例高OHSS风险患者；HCG 2500 IU，