ksmaКубанский научный медицинский вестникKuban Scientific Medical Bulletin1608-62282541-9544Kuban State Medical University10.25207/1608-6228-2020-27-6-136-148ksma-2237Research ArticleОБЗОРЫREVIEWПоддержка лютеиновой фазы у пациентов с риском развития синдрома гиперстимуляции яичников в программах вспомогательных репродуктивных технологий (обзор)Luteal Support and Risk of Ovarian Hyperstimulation in Assisted Reproduction (A Review)https://orcid.org/0000-0002-9907-7491КрутоваВ. А.KrutovaV. A.

Крутова Виктория Александровна — доктор медицинских наук, профессор кафедры акушерства, гинекологии и перинатологии федерального государственного бюджетного образовательного учреждения высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации; главный врач Клиники федерального государственного бюджетного образовательного учреждения высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации 

ул. Зиповская, д. 4/1, 4/3, г. Краснодар, 350010ул. им. Митрофана Седина, д. 4, Краснодар, 350063 

Victoria A. Krutova — Dr. Sci. (Med.), Prof., Chair of Obstetrics, Gynaecology and Perinatology, Kuban State Medical University; Chief Physician, Kuban State Medical University Clinic

Zipovskaya str., 4/1, 4/3, Krasnodar, 350010Mitrofana Sedina str., 4, Krasnodar 350063 

https://orcid.org/0000-0002-6941-2770БаклаковаА. А.BaklakovaA. A.

 Баклакова Алиса Антиноевна — аспирант кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, Краснодар, 350063тел.: +7 (909) 4562919 

Alice A. Baklakova — Postgraduate Student, Chair of Obstetrics, Gynaecology and Perinatology

Mitrofana Sedina str., 4, Krasnodar 350063+7 (909) 4562919 

e-alisa@bk.ruКлиника федерального государственного бюджетного образовательного учреждения высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKuban State Medical University Clinic; Kuban State Medical UniversityRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKuban State Medical UniversityRussian Federation202013102020276136148Copyright © Крутова В.А., Баклакова А.А., 20202020Крутова В.А., Баклакова А.А.Krutova V.A., Baklakova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ksma.elpub.ru/jour/article/view/2237Введение

Введение. Использование агониста гонадотропин-рилизинг-гормона в качестве триггера овуляции в программах экстракорпорального оплодотворения привело к значительному снижению риска синдрома гиперстимуляции яичников, но при этом возникла необходимость усиленной поддержки лютеиновой фазы в циклах с переносом свежих эмбрионов.

Цель обзора — предоставить информацию о современных методах поддержки лютеиновой фазы после смены триггера овуляции в программах экстракорпорального оплодотворения/интрацитоплазматической инъекции сперматозоидов, оценить целесообразность и безопасность применения агониста гонадотропин-рилизинг-гормона в посттрансферном периоде.

Методы

Методы. Поиск публикаций осуществлялся по базам PubMed, E-library, Web of science, Cochrane Library, Cyberleninca. Глубина поиска — 10 лет. Системный поиск осуществлялся по следующим ключевым словам: агонист гонадотропин-рилизинг-гормона, поддержка лютеиновой фазы, триггер овуляции, экстракорпоральное оплодотворение, синдром гиперстимуляции яичников.

Результаты

Результаты. Проанализировано 96 источников литературы, из них в обзор вошло 35. В целом обзор проведенных в настоящее время исследований показал существенную эффективность добавления агониста гонадотропин-рилизинг гормона для поддержки лютеиновой фазы, повышение успешности программ экстракорпорального оплодотворения/интрацитоплазматической инъекции сперматозоидов и переноса эмбрионов, улучшение исходов беременности. Добавление микродоз хорионического гонадотропина к стандартной поддержке лютеиновой фазы препаратами прогестерона также повышает частоту наступления беременности в программах вспомогательных репродуктивных технологий, но это может привести к развитию позднего синдрома гиперстимуляции яичников и должно применяться с осторожностью.

Заключение

Заключение. Добавление агониста гонадотропин-рилизинг-гормона в лютеиновую фазу может улучшить исходы беременности в циклах экстракорпорального оплодотворения/интрацитоплазматической инъекции сперматозоидов у пациентов с риском развития синдрома гиперстимуляции яичников после смены триггера овуляции. Тем не менее необходимо дальнейшее изучение эффективности и безопасности применения агониста гонадотропин-рилизинг-гормона для поддержки лютеиновой фазы в циклах переноса свежих эмбрионов.

Background

Background. Gonadotropin-releasing hormone agonist as an ovulation trigger effectively reduces the ovarian hyperstimulation risk in in vitro fertilisation protocols, at the same time requiring an effective luteal phase support in embryo transfer cycles.

Objectives

Objectives. A review of modern approaches to luteal support after the ovulation trigger switch in in vitro fertilisation/intracytoplasmic sperm injection protocols; assessment of feasibility and safety of gonadotropin-releasing hormone agonist in the post-transfer period.

Methods

Methods. Literature sources were mined in the PubMed, eLibrary, Web of Science, Cochrane Library, Cyberleninka databases at a depth of 10 years. The query keywords were: gonadotropin-releasing hormone agonist, luteal phase support, ovulation trigger, in vitro fertilisation, ovarian hyperstimulation syndrome.

Results

Results. The review included 35 records selected from the 96 analysed total. The analysis reveals a sensible efficiency of gonadotropin-releasing hormone agonist for the luteal phase support, improved success of in vitro fertilisation/intracytoplasmic sperm injection and embryo transfer strategies, improved pregnancy outcomes. Microdosing of chorionic gonadotropin to supplement standard progesterone luteal support also improves the pregnancy outcome rate in assisted reproduction, however, at the risk of late ovarian hyperstimulation syndrome and should be applied with caution.

Conclusion

Conclusion. Administration of gonadotropin-releasing hormone agonist for luteal support may improve pregnancy outcomes in in vitro fertilisation/intracytoplasmic sperm injection protocols in patients with the ovarian hyperstimulation risk after the ovulation trigger switch. Nevertheless, further research is necessary into the efficacy and safety of gonadotropin-releasing hormone agonist for luteal support in embryo transfer cycles.

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The authors declare that there are no conflicts of interest present.