FSH/LH控制性超排卵30年

<正> 众所周知,世界首例试管婴儿是Steptoe医生在自然周期条件下监测排卵,取得成熟卵子,并经体外受精获得成功。要说当时监测卵泡发育的条件,取卵与受精过程不比现在方便与完善。经体外受精-胚胎移植(IVF-ET)、妊娠发生与胚胎发育、妊娠持续,于1978年分娩活胎的Louis Brown来到人类

Three decades of controlled ovarian stimulation with follicle stimulating hormone/luteinizing hormone

As we know, the first ＂test tube baby＂ was achieved by monitoring the follicle development in the natural cycle and single oocyte pick-up, which is rather a hard work with low pregnancy rate. With the introduction of super-ovulation, the assisted reproductive techniques have become more effective and the pregnancy rate has increased. However, clomiphene and HMG used in controlled ovarian stimulation （COS） may induce a premature luteinizing hormone （LH） surge during the stimulation, resulting in poor quality oocyte, lower implantation rate, higher miscarriage rate and cycle cancellation rate. The down regulation with GnRH-a was therefore developed to prevent these problems, combined with the pure follicle stimulating hormone （FSH, without LH） or recombinant FSH in COS. After a few years of clinical practice, poor responses, lower implantation rate and higher miscarriage rate occurred once again in this protocol caused by LH insufficiency. Addition of LH is proven to be critical during the follicle development in COS. How much dose of LH and what time to administer it in the cycle need a detailed discussion. In COS cycle, the dosage of GnRH-a/Gonadotropins （Gn） administered is controversial. The stronger the down regulation with GnRH-a, the higher dose of Gn is needed. The minimal stimulation protocol in COS has been in practice with a better result. Considering the deleterious effects of high Gn level on the ooeytes during COS, mild stimulation is an ideal alternative. At present, the individualized COS protocols are under way.