多囊卵巢综合征患者行体外受精-胚胎移植中应用不同类型促性腺激素的临床结局比较

Comparison of clinical outcomes of different types of gonadotropins used in vitro fertilization-embryo transfer in patients with polycystic ovary syndrome

目的比较不同类型促性腺激素(Gn)在多囊卵巢综合征(PCOS)患者中体外受精-胚胎移植的效果。方法回顾性收集2019年1月至2021年6月于华西第二医院行体外受精-胚胎移植并接受拮抗剂方案促排的不孕PCOS患者共383例,根据控制性卵巢刺激(COS)中采用的Gn,分为进口重组人促卵泡激素α(进口rFSHα)组、进口重组促卵泡素β(进口rFSHβ)组、国产重组人促卵泡激素α(国产rFSHα)组和国产尿卵泡刺激素(国产uFSH)组。比较四组COS情况、体外受精-胚胎移植结局以及并发症等情况。结果与uFSH组相比,三组重组FSH在COS中Gn用量更少、用时更短,获得胚胎更多(P<0.05),rFSHα和rFSHβ在COS和胚胎方面差异无统计学意义(P>0.05)。与国产rFSHα相比,进口rFSHα的活性更高,获得优质囊胚更多,但国产rFSHα组取消新鲜移植率较低(P<0.05)。结论在PCOS患者辅助生殖诊疗中,重组FSH可能优于uFSH,进口rFSHα更利于获得优质囊胚,而国产rFSHα更利于新鲜胚胎移植。

Objective To compare the effect of different gonadotropins(Gn)used in vitro fertilization-embryo transfer(IVF-ET)in patients with polycystic ovary syndrome(PCOS).Methods A total of 383 patients who werediagnosed with PCOS and underwent reproductive treatment between January 2019 and June 2021 in the Reproductive Medical Center of our hospital were included in this retrospective study.Based on different Gn drugs of controlled ovarian stimulation(COS),the patients were divided into animported recombinant human follicle-stimulating hormoneαgroup(imported rFSH-αgroup),an imported recombinant human follicle-stimulating hormoneβgroup(imported rFSH-βgroup),a domestic recombinant human follicle-stimulating hormoneαgroup(domestic rFSH-αgroup),and adomestic urinary follicle-stimulating hormonegroup(domestic uFSH group).The COS,IVF-ET outcomes and complications were compared among the four groups.Results Compared with the uFSH group,Gn dosage and duration were decreased and more embryos were obtained in the three rFSH groups(P<0.05).There was no significant difference in the COS parameters and reproductive outcomes between the rFSH-αgroup and the rFSH-βgroup(P>0.05).Compared with domestic rFSH-α,imported rFSH-αcould be more active and had more high-quality blastocysts.However,the fresh transplantation cancel rate was lower in the domestic rFSH-αgroup(P<0.05).Conclusion The rFSH may be a better option for PCOS patients receiving IVF-ET than uFSH.Imported rFSH-αmay have more high-quality blastocysts and domestic rFSH-αmay be more suitable for fresh embryo transfer.