多囊卵巢综合征患者个体化辅助生殖助孕策略与难点

Strategies and difficulties of individualized assisted reproduction technology for patients with polycystic ovary syndrome

多囊卵巢综合征(PCOS)是导致育龄期女性不孕的重大疾病之一,严重影响患者身心健康。PCOS患者往往存在下丘脑-垂体-卵巢轴功能异常和代谢紊乱,严重损害正常的生殖过程。辅助生殖技术是PCOS相关不孕症的重要治疗手段,但患者的卵巢高反应状态使卵巢过度刺激综合征(OHSS)的风险升高,增加患者的治疗风险与经济负担。为提高妊娠率、减少OHSS风险、改善辅助生殖助孕的临床结局,临床医生需要在辅助生殖助孕的全过程进行综合干预。如何全面优化PCOS患者辅助生育助孕过程的管理策略是近年来的研究热点。本文旨在结合本团队既往的研究结果和临床经验,从超促排卵前的预处理、卵巢刺激方案、促排药物类型和剂量、OHSS预防策略等方面对目前PCOS患者辅助生殖助孕策略的现状和难点进行评述,以期进一步推动PCOS患者个体化辅助生殖助孕策略的临床应用和科学研究。

Polycystic ovary syndrome(PCOS)is a common disease leading to infertility for women of childbearing age,damaging the physical and mental health of patients.The abnormal function of hypothalamus-hypophysis-ovary axis and metabolic disorders in PCOS have abundant adverse effects on female reproduction.Assisted reproductive technology(ART)is important means to address the infertility of PCOS,but the high ovarian response of patients increases the risk of ovarian hyperstimulation syndrome(OHSS)and increases the risk and burden of patients subsequently.In order to improve the clinical outcome of ART and decrease the risk of OHSS,it is necessary to optimize the whole process of ART by clinicians.How to optimize the ART strategy for PCOS patients is a hot point in recent years.In this paper,we reviewed the critical points in the whole ART process of PCOS patients,including preconditioning before controlled ovarian stimulation,ovarian stimulation protocol,types and dosages of drugs,and other OHSS prevention strategies,as combined with our team's previous research results and clinical experiences.All above in order to promote the clinical application and research on the individualized ART strategies for PCOS patients.