In natural cycles,the FSH threshold of antral follicle cochort is different.For that reason,the development of each follicle is not synchrony.The mechanism of which follicle will develop and how many follicles can dev...In natural cycles,the FSH threshold of antral follicle cochort is different.For that reason,the development of each follicle is not synchrony.The mechanism of which follicle will develop and how many follicles can develop is not sure.The destined to be matured oocyte follicle should be gathered during luteal-follicular transition phase.The luteal-follicular transition phase is defined as the period from previous luteal phase at which time the estrodial and progesterone reduced dramatically to the selection phase of next cycle.It is indicated by menorrhea and regarded as an important transition phase in normal cycles.The FSH begins to elevate 2 days before menorrhea.Follicles were collected during that period.The elevation of FSH during luteal-follicular transition phase is important for follicle collection,selection and can prevent follicle atresia.The asychronization of follicles in controlled ovary stimulation can reduce available oocytes and embryos,and subsequently reduce pregnancy rate.The reason of follicle asychronization could be the following:1.Advanced age.In aging women,the follicular phase is advanced.The antral follicles were asynchrony in size when Gn injection at early follicular phase.2.The threshold of each follicular is quite different,or the initiate dose of Gn is not enough for the follicle development.The follicles with less sensitivity grow slower.That is probably one of the reasons of follicle asynchrony.3.It is the intrinsic characteristic of COS.In GnRH antagonist protocol and GnRH agonist flare-up protocol,the FSH is not inhibited during luteal phase.The follicle collection begins before Gn injection.The Gn promotes the asynchrony of follicle.The elevation of FSH at luteal-follicular transition phase is the main reason of asynchrony.The purpose of improvement follicular synchronization is to reduce the FSH level during luteal-follicular transition phase.The antral follicles keeping quiescence before Gn injection will be benefit for collection of more synchrony follicles.The protocols inc展开更多
文摘目的 比较高孕激素状态促排卵(PPOS)方案与GnRH拮抗剂方案(GnRH-ant)在高龄患者促排卵中应用的效果。 方法 回顾性分析2017年1月至2018年10月在我院生殖医学中心行IVF/ICSI助孕的高龄女性(>35岁)临床资料,包括GnRH-ant组70例与PPOS方案组230例,比较两种方案促排卵治疗前后情况。 结果 两组患者年龄、不孕年限、BMI、AFC、基础E 2 、基础FSH、基础LH等基本资料均无明显统计学差异( P >0.05)。两组患者GnRH-ant组的HCG日E 2 水平、Gn总量和天数、胚胎数、2PN数、早发LH峰发生率及优胚率均无统计学差异( P >0.05)。GnRH拮抗剂的获卵数[(5.32±3.71)vs.(4.20±2.75)]、卵裂数[(3.69±2.95)vs.(2.95±2.33)]、优胚数[(2.32±2.05)vs.(1.80±1.67)]均显著多于PPOS组( P <0.05);GnRH-ant组的HCG日孕酮水平[(2.24±1.93)vs.(3.77±3.42)nmol/L]显著小于PPOS组( P <0.01)。 结论 本研究发现在高龄(>35岁)患者行IVF/ICSI助孕的患者中,GnRH-ant方案和PPOS方案相比较,两者在抑制早发LH峰发生率上没有明显的差异,但是GnRH-ant方案可以获得较多的优质胚胎,因此患者可能有更好的助孕结局。
文摘In natural cycles,the FSH threshold of antral follicle cochort is different.For that reason,the development of each follicle is not synchrony.The mechanism of which follicle will develop and how many follicles can develop is not sure.The destined to be matured oocyte follicle should be gathered during luteal-follicular transition phase.The luteal-follicular transition phase is defined as the period from previous luteal phase at which time the estrodial and progesterone reduced dramatically to the selection phase of next cycle.It is indicated by menorrhea and regarded as an important transition phase in normal cycles.The FSH begins to elevate 2 days before menorrhea.Follicles were collected during that period.The elevation of FSH during luteal-follicular transition phase is important for follicle collection,selection and can prevent follicle atresia.The asychronization of follicles in controlled ovary stimulation can reduce available oocytes and embryos,and subsequently reduce pregnancy rate.The reason of follicle asychronization could be the following:1.Advanced age.In aging women,the follicular phase is advanced.The antral follicles were asynchrony in size when Gn injection at early follicular phase.2.The threshold of each follicular is quite different,or the initiate dose of Gn is not enough for the follicle development.The follicles with less sensitivity grow slower.That is probably one of the reasons of follicle asynchrony.3.It is the intrinsic characteristic of COS.In GnRH antagonist protocol and GnRH agonist flare-up protocol,the FSH is not inhibited during luteal phase.The follicle collection begins before Gn injection.The Gn promotes the asynchrony of follicle.The elevation of FSH at luteal-follicular transition phase is the main reason of asynchrony.The purpose of improvement follicular synchronization is to reduce the FSH level during luteal-follicular transition phase.The antral follicles keeping quiescence before Gn injection will be benefit for collection of more synchrony follicles.The protocols inc
