来曲唑微刺激促排卵方案在IVF中的应用.pptVIP

来曲唑微刺激促排卵方案在IVF中的应用 湖北省十堰市人民医院生殖医学中心 张昌军 IVF促排卵方案的变迁与发展 促排卵是IVF的关键步骤之一 经典的促排卵方案在提高妊娠率的同时存在依赖外源性Gn，费用高，费时，OHSS，多胎妊娠等弊端 微刺激促排卵方案因其低费用、简便、并发症少、与传统方案相当的累积妊娠率逐渐受到重视 微刺激促排卵方案 微刺激的定义： 卵巢微刺激方案，是相对于传统的控制性超促排卵方案来说的。从形式上看，凡是可能对卵巢刺激轻微、不对脑垂体进行降调节或升调节处理的促排卵方案，都堪称微刺激方案 常用的微刺激促排卵方案： 1.CC/Gn/GnRHa CC的E2受体阻断作用的弊端 2.LE/Gn/GnRHa：LE的剂量相关、不完全、可逆性 3.小剂量Gn 来曲唑微刺激促排卵 芳香化酶是催化雌激素合成的最后步骤的限速酶,可分别将雄烯二酮和睾酮转化为雌酮和雌二醇 芳香化酶抑制剂显著、特异地抑制芳香化酶活性, 显著降低雌激素水平 来曲唑（Letrozole ）是第三代芳香化酶抑制剂，特异地抑制芳香化酶活性, 显著降低雌激素水平，作用具有可逆性 Letrozole Works as Well as Clomiphene for Inducing Ovulation SN DIEGO -- The antineoplastic agent letrozole is a promising alternative to clomAiphene citrate as a frontline treatment for ovulation induction, results of a small prospective study suggest. While both drugs are antiestrogenic, letrozoles relatively short half-life and its lack of effect on estrogen receptors help avoid the undesirable side effects of clomiphene citrate, Dr. Mohamed Mitwally reported at the annual meeting of the American Society for Reproductive Medicine. Letrozole (Femara) is indicated for the treatment of advanced breast cancer in postmenopausal women with disease progression following antiestrogen therapy. It has a half-life of about 45 hours, while the half-life for clomiphene citrate ranges from 2 weeks to 2 months. “Clomiphene citrate may be the gold standard drug used for ovulation induction in women with unexplained infertility, but it leads to peripheral antiestrogenic effects, such as unfavorable cervical mucus and a very thin endometrium, said Dr. Mitwally 雌激素合成的途径 来曲唑促排卵作用机制 抑制芳香化酶活性阻止雌激素合成，降低体内雌激素水平, 解除E2 对下丘脑/垂体的负反馈抑制，促进内源性Gn分泌 在卵巢水平阻断雄激素向雌激素的转化 卵巢局部累积的雄激素促进颗粒细胞FSH受体表达，放大FSH效应 促进IGF等生长因子的表达 来曲唑促排卵的特点 不完全 剂量相关 可逆性 不抑制内膜的发育 中枢对雌激素的负反馈、正反馈反应机制不受影响 国内外研究进展 单纯用于促排卵 促排卵结合人工授精 促排卵结合IVF-ET 2000年Mitwally首次证明了临床上LE 的 促排卵作用 Mitwally M Casper R. The aromatase inhibitor, letrozole:a promising alternative for clomiphene citrate for induction of ovulation. Fertil Steril, 2000,