IVF控制性促排卵的新概念课件
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• 獲得1例繼續妊娠
Porter et al., 1984
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRHa 長方案 vs 無降調節
Agonist Studies 2000 - 2001
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRH抑制剂
副作用
• 过度抑制:
meta-分析
Odds ratios for IVF clinical pregnancy after GnRH-a versus clomiphene/FSH/hMG ovulation induction protocols
降調節
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRH 抑制剂结构
改变GnRH的自然结构生成 GnRH抑制剂
1 2 3 4 5 6 7 8 9 10
pyro (Glu) – His – Trp – Ser – Tyr – Gly – Lwenku.baidu.comu – Arg – Pro – Gly – NH2
激活 GnRH受体
调节 GnRH 受体亲和力
调节生物活性
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
• 回顧 “金標準” • 討論替代方法 • 介紹IVF中卵巢準備的概念
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
學習的目的
• 在ART治療中易接受的治療方 法現狀
IVF中的卵巢刺激
• 自然周期 • Clomiphene, Clomiphene/HMG • HMG • FSH/GnRH抑制劑刺激方案 • FSH/GnRH拮抗劑刺激方案
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
首次使用GnRH-抑制劑長方 案結果
• 11 例IVF • GnRH抑制劑. (buserelin) 於月經
第一天開始用 • 開始用HMG或 FSH 刺激卵巢，
when all ovarian follicles and the endometrial lining has disappeared on ultrasound (average 15 days)
GnRH 拮抗剂的结构
为了达到拮抗的效果,而改变更多的 GnRH自然结构 而不仅仅是6位和10位氨基酸
1 2 3 4 5 6 7 8 9 10
pyro (Glu) – His – Trp – Ser – Tyr – Gly – Leu – Arg – Pro – Gly – NH2
激活 GnRH受体
调节
GnRH 受体亲和力
调节生物活性
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
比较
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
• 將來更好的易接受的治療方法.
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
藥物刺激下的卵巢
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
過早LH峰
• 質量差 • 不受精或妊娠率極低 • 取消取卵手術
5-20%
All cycles treated in early 1980’s
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
IVF控制性促排卵的新概念
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
– LH 过低,影响雌激素的产生以及黄体期孕酮的产生 – 导致低反应, 早期流产等不良妊娠结局.
其他: • 疗程过长,用药更多,花费更多,取消周期多,非自
然
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Porter et al., 1984
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRHa 長方案 vs 無降調節
Agonist Studies 2000 - 2001
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRH抑制剂
副作用
• 过度抑制:
meta-分析
Odds ratios for IVF clinical pregnancy after GnRH-a versus clomiphene/FSH/hMG ovulation induction protocols
降調節
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
GnRH 抑制剂结构
改变GnRH的自然结构生成 GnRH抑制剂
1 2 3 4 5 6 7 8 9 10
pyro (Glu) – His – Trp – Ser – Tyr – Gly – Lwenku.baidu.comu – Arg – Pro – Gly – NH2
激活 GnRH受体
调节 GnRH 受体亲和力
调节生物活性
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
• 回顧 “金標準” • 討論替代方法 • 介紹IVF中卵巢準備的概念
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
學習的目的
• 在ART治療中易接受的治療方 法現狀
IVF中的卵巢刺激
• 自然周期 • Clomiphene, Clomiphene/HMG • HMG • FSH/GnRH抑制劑刺激方案 • FSH/GnRH拮抗劑刺激方案
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
首次使用GnRH-抑制劑長方 案結果
• 11 例IVF • GnRH抑制劑. (buserelin) 於月經
第一天開始用 • 開始用HMG或 FSH 刺激卵巢，
when all ovarian follicles and the endometrial lining has disappeared on ultrasound (average 15 days)
GnRH 拮抗剂的结构
为了达到拮抗的效果,而改变更多的 GnRH自然结构 而不仅仅是6位和10位氨基酸
1 2 3 4 5 6 7 8 9 10
pyro (Glu) – His – Trp – Ser – Tyr – Gly – Leu – Arg – Pro – Gly – NH2
激活 GnRH受体
调节
GnRH 受体亲和力
调节生物活性
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
比较
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
• 將來更好的易接受的治療方法.
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
藥物刺激下的卵巢
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
過早LH峰
• 質量差 • 不受精或妊娠率極低 • 取消取卵手術
5-20%
All cycles treated in early 1980’s
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
IVF控制性促排卵的新概念
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
– LH 过低,影响雌激素的产生以及黄体期孕酮的产生 – 导致低反应, 早期流产等不良妊娠结局.
其他: • 疗程过长,用药更多,花费更多,取消周期多,非自
然
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time