卵巢高反应人群的标准化管理ppt课件.ppt

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。 * * 二甲双胍在IVF中的应用 Hum Reprod 21:1387, 2006 Metformin does not improve IVF pregnancy (OR = 1.29; 95% CI = 0.84–1.98) or live birth (OR = 2.02, 95% CI = 0.98–4.14)rates, but reduces the risk of OHSS (OR = 0.21; 95% CI = 0.11–0.41, P 0.00001). Eight RCTs were included 强的松在预防OHSS中的应用 复发性流产，内异症 降低VEGF表达，抑制血管舒张，阻止血管通透性的增加，减轻渗出 预防OHSS fertil steril 78:529-33;2002 白蛋白： 一种血浆结合蛋白，增加血浆胶体渗透压。与OHSS发生相关的血管活性物质相结合，加快有害物质的清除。 价格贵，传染血液传播性疾病的风险。 羟乙基淀粉：第３代血浆代用品，有效维持胶体渗透压，改善循环和器官灌注。 非生物制剂，能避免血液制品的潜在风险如病毒感染等问题，费用低廉，来源方便 ——可作为白蛋白的替代预防OHSS 静脉用药预防OHSS 白蛋白，羟乙基淀粉HES预防OHSS的有效性评估 Nine R