人工協助生殖理想的引卵療程

Optimal Ovulation Stimulation Protocols for in Vitro Fertilization

詹景全(Chying-Chyuan Chan) ； 金承惠(Chen-Hui Jin) ； 武國璋(Gwo-Jang Wu) ； 鍾明宗(Ming-Tzeung Chung) ； 彭忠衎(Chung-Kan Peng)

《北市醫學雜誌》 3卷11期 (2006/11) Pp. 18-28

https://doi.org/10.6200/TCMJ.2006.3.11.03

摘要

在過去25年來，不孕症治療的專家不斷的發展各種引卵的配方：目的就是在引出更多健康的卵子，來增加試管嬰兒的成功率。儘管第一個試管嬰兒是採取自然週期，取出排卵前的卵子，在體外受孕的。但是不孕症治療專家早就揚棄這種方式，改由人工引卵的方式。他們比較喜歡用性腺激素(gonadotropin)來刺激多一些成熟的卵子來增加懷孕率。但是利用基因合成的性腺刺激素，是否較傳統由尿液萃取出的性腺刺激素，來得有效或安全?基因合成的性腺刺激素是否能完全取代傳統由尿液萃取出來的性腺刺激素？使用濾泡刺激素(FSH)來引卵，是否需要加上黃體激素(LH)？性腺刺激素釋放激素拮抗劑，是否能完全取代性腺刺激素釋放激素促效劑用來抑制早發性排卵及早發性黃體化？固定劑量的性腺刺激素配方比較適合試管嬰兒，還是多種藥品的複合式配方比較好？最理想的引卵配方，是一種能引出最多卵子，進到最高受孕率及懷孕率，避免最多的危險及減少監測次數的人性化方式。本篇文章的目的就是在整理及回顧近年來各種使用於人工協助生殖的引卵配方，企圖找到這種黃金配方。

關鍵字

引卵 ； 性腺刺激素 ； 性腺刺激素釋放激素促效劑和拮抗劑 ； 濾泡刺激素 ； 黃體刺激素 ； 人類絨毛膜激素 ； 口服排卵藥

並列摘要

On the past two and half decades, experts in the infertility treatment have continuously developed various different approaches to stimulating ovulation. This is driven by the need to obtain more and better follicles, which then allows improvement in the success rate of in vitro fertilization (IVF). Although the first IVF oocyte was retrieved before its ovulation, was under a natural cycle and was fertilized externally, the experts have already discarded this method. Instead, the major approach used is the control of ovulation induction. Experts prefer the use of gonadotropins to stimulate mature follicles and thus to increase the pregnancy rate. However, there are some issues that occur regarding the safety and effectiveness of gonadotropins. These include whether it is possible for recombinant gonadotropins to fully replace traditional urinary production of gonadotropins extracted from the urine, whether when follicle-stimulating hormone is used to induce ovulation there is a need for luteinizing hormone (LH), whether gonadotropinreleasing hormone antagonists can replace the gonadotropin-releasing hormone agonists in order to suppress premature LH surge and finally, whether ”simplified” or ”minimal” stimulation protocols for IVF are better than the traditional approach. An ideal ovulating protocol needs to produce the largest number of the mature follicles and, furthermore, it must also give the highest success rate in terms of fertility and pregnancy. It should also, for ethical reasons, avoid dangerous side effects and minimize invasive procedures. In this review, we will discuss the various ovulation protocols available for IVF and attempt to identify the gold standard among such protocols.

並列關鍵字

Ovarian stimulation ； gonadotropins ； gonadotropin-releasing hormone agonists and antagonists ； follicle-stimulating hormone ； luteinizing hormone ； human chrionic gonadotropin ； clomiphene citrate