未來誘導排卵(COH)趨勢

未來誘導排卵之趨勢為
排卵針劑越用越少
卵子數量越來越少
植入胚胎數量越來越少
療程縮短
降低用藥複雜度
外用口服藥取代針劑
GnRHantagonist結合溫和刺激之誘導排卵取代長療程GnRHagonist

http://humrep.oxfordjournals.org/content/25/11/2678.full

Mild ovarian stimulation for IVF: 10 years later

1. Bart C.J.M. Fauser1,*, 
2. Geeta Nargund2, 
3. Anders Nyboe Andersen3,
4. Robert Norman4, 
5. Basil Tarlatzis5, 
6. Jacky Boivin6 and 
7. William Ledger7

+Author Affiliations

1. ¹Department of Reproductive Medicine and Gynaecology, University Medical Center, Utrecht, The Netherlands
2. ²Department of Reproductive Medicine, St George's Hospital and Medical School, London, UK
3. ³The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
4. ⁴Robinson Institute, Discipline of Obstetrics and Gynaecology, School of Pediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
5. ⁵1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University, Thessaloniki, Greece
6. ⁶School of Psychology, Cardiff University, Cardiff, UK
7. ⁷Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK

1. *Correspondence address. E-mail: b.c.fauser@umcutrecht.nl

 

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Abstract

Ovarian stimulation to achieve multiple follicle development has been an integral part of IVF treatment. In the context of improved laboratory performance, the need for a large number of oocytes as an integral part of a successful IVF programme may be questioned. The aim of the current debate is to summarize the studies performed during the last decade to develop the concept of mild stimulation aiming to obtain fewer than eight oocytes. Here we examine the balance between IVF success and patient discomfort, and complications and cost, and how these might improve by simpler ovarian stimulation protocols aimed at retrieving fewer oocytes. We intend to analyse why progress has been rather slow and why there is much resistance to mild stimulation. Finally, presumed useful directions for future research will be discussed.

Figure 1

Schematic representation of the FSH threshold/window concept in relation to single dominant follicle selection during the follicular phase of the normal menstrual cycle, multiple follicle development and high FSH levels in conventional ovarian hyperstimulation when compared with more subtle interference with decreasing FSH concentrations. From Macklon et al. Endocrine Reviews 2006 (with permission).