体外受精-胚胎移植屈螺酮炔雌醇预处理对多囊卵巢综合征妊娠结局的影响

Effect of preconditioning with drospirosterone ethinylestradiol for in vitro fertilization-embryo transfer on pregnancy outcome in polycystic ovary syndrome

目的探讨体外受精-胚胎移植(IVF-ET)屈螺酮炔雌醇预处理对多囊卵巢综合征(PCOS)患者妊娠结局的影响。方法回顾性分析2022年3月至2023年4月周口市中心医院收治的70例PCOS患者的临床资料,按照治疗方法不同分组,其中36例在IVF-ET治疗前未使用屈螺酮炔雌醇处理者纳入对照组,34例在IVF-ET治疗前使用屈螺酮炔雌醇处理者纳入观察组。治疗3个周期后,比较两组患者的妊娠结局,以及治疗前后的性激素水平、子宫内膜厚度、窦卵细胞数目、卵巢体积、胰岛素指数、胰岛素抵抗指数,同时比较两组患者的不良反应发生情况。结果治疗后,观察组患者的临床妊娠率为67.65%,高于对照组的52.78%,流产率和异位妊娠率分别为2.94%、2.94%,低于对照组的8.33%、5.56%,但差异均无统计学意义(P>0.05)。治疗前,两组患者的促性腺激素血清促卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)、抗苗勒氏管激素(AMH)水平比较差异均无统计学意义(P>0.05);治疗3个周期后,对照组患者的FSH、T、AMH高于治疗前,LH、E2低于治疗前,但差异无统计学意义(P>0.05);治疗3个周期后,观察组患者的FSH、AMH水平均高于治疗前且明显高于对照组,LH、T、E2水平低于治疗前且明显低于对照组,差异均有统计学意义(P<0.05)。治疗3个周期后,两组患者的子宫内膜厚度均大于治疗前,且观察组明显大于对照组,窦卵细胞数目和卵巢体积均小于治疗前,且观察组明显小于对照组,差异均有统计学意义(P<0.05)。治疗3个周期后,两组患者的胰岛素指数、胰岛素抵抗指数均低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。治疗期间,观察组患者的不良反应总发生率为5.88%,略低于对照组的11.11%,但差异无统计学意义(P>0.05)。结论PCOS患者IVF-ET治疗前使用屈螺酮炔雌醇处理可显著改善患者的性激素水平,增加其子宫内膜厚度和卵巢体积,从而改善妊娠结局。

Objective To investigate the effect of preconditioning with drospirosterone ethinylestradiol for in vitro fertilization-embryo transfer(IVF-ET)on pregnancy outcome of patients with polycystic ovary syndrome(PCOS).Methods The clinical data of 70 patients with PCOS admitted to Zhoukou Central Hospital from March 2022 to April 2023 were retrospectively analyzed.According to different treatment methods,36 patients who did not use drospirenone ethinylestradiol before IVF-ET treatment were included in the control group,and 34 patients who used drospirenone and ethinylestradiol before IVF-ET treatment were included in the observation group.After 3 cycles of treatment,the pregnancy outcomes of the two groups were compared,as well as the levels of sex hormones,endometrial thickness,number of sinus oocytes,ovarian volume,insulin index and insulin resistance index before and after treatment.At the same time,the adverse reactions of the two groups were compared.Results After treatment,the clinical pregnancy rate was 67.65%in the observation group and 52.78%in the control group,while the abortion rate and ectopic pregnancy rate were 2.94%and 2.94%in the observation group and 8.33%and 5.56%in the control group,with no statistically significant differences between the two groups(P>0.05).Before treatment,there was no significant difference in the levels of Serum follicle stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),estradiol(E2),anti-Mullerian hormone(AMH)between the two groups(P>0.05).After 3 cycles of treatment,FSH,T,and AMH in the control group were slightly higher than those before treatment,while LH and E2 levels were slightly lower than those before treatment,with no statistically significant differences(P>0.05).After 3 cycles of treatment,the levels of FSH and AMH in the observation group were significantly higher than those before treatment and those in the control group,and the levels of LH,T,and E2 were significantly lower than those before treatment and those in the control group,with statistically significant differences(P<0.05).After 3 cycles of treatment,the endometrial thickness of the observation group and the control group was greater than that before treatment,and the thickness in the observation group was greater than that in the control group;the number of sinus egg cells and ovarian volume were less than those before treatment,and the number of sinus egg cells and ovarian volume in the observation group were less than those in the control group;the differences were statistically significant(P<0.05).After 3 cycles of treatment,the insulin index and insulin resistance index of the two groups were significantly lower than those before treatment,while the indexes in the observation group were significantly lower than those in the control group;the differences were statistically significant(P<0.05).During the treatment,the total incidence of adverse reactions in the observation group was 5.88%,which was slightly lower than 11.11%in the control group,but the difference was not statistically significant(P>0.05).Conclusion The use of drospirenone and ethinylestradiol before IVF-ET treatment in PCOS patients can significantly improve the sex hormone levels of patients,increase their endometrial thickness and ovarian volume,thereby improving the pregnancy outcome.