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控制性卵巢刺激(COS)中,可以观察到晚卵泡期孕激素升高(PE)的现象。卵泡刺激素(FSH)和黄体生成素(LH)作用于颗粒细胞,促使胆固醇转化为孕酮(P),卵泡膜细胞也能产生足够数量的P。P在卵泡膜细胞内的LH作用下进一步转化为雄激素,孕酮产生的来源过多或者无法及时代谢都会造成循环中的P升高,进而降低子宫内膜容受性,影响体外受精-胚胎移植(IVF-ET)的结局。P水平与成熟卵泡数目、雌激素水平、FSH总剂量正相关,LH过高或过低都促使P升高。与拮抗剂方案相比,降调节超排卵并不增加P升高的几率。选用温和的COS方案、减少FSH剂量、调整外源性FSH/HMG的用药比例、提前HCG诱发排卵时间、全胚冷冻后解冻移植、囊胚移植等方法可以避免P升高导致的不利影响。
Controlled ovarian stimulation (COS), the late follicular phase of progesterone can be observed elevated (PE) phenomenon. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) act on granulosa cells to promote the conversion of cholesterol to progesterone (P), which also produces a sufficient number of P’s. P is further converted to androgens under the action of LH in the cell of the antral follicle. Progesterone produces too much or can not be timely metabolized, resulting in a cyclic increase of P, which in turn decreases endometrial receptivity and affects in vitro fertilization-embryo Transplantation (IVF-ET) outcome. P level and the number of mature follicles, estrogen levels, total dose of FSH is positively correlated, LH is too high or too low to promote P increased. Down-regulation of superovulation did not increase the risk of P-elevation compared with the antagonist regimen. Selection of mild COS regimen, reducing the dose of FSH, adjusting the proportion of exogenous FSH / HMG medication, ovulation induction time ahead of HCG, whole embryo thawing after thawing transplantation, blastocyst transplantation and other methods can avoid the adverse effects caused by elevated P.