口服避孕药预处理对不同人群控制性超促排卵过程中卵巢过度刺激综合征发病的影响

The impact of oral contraceptives pretreatment on morbidity of early and late ovarian hyperstimulation syndrome after controlled ovarian hyperstimulation of different population

目的研究口服避孕药(OC)预处理对不同卵巢反应人群控制性超促排卵过程中早发及晚发卵巢过度刺激综合征(OHSS)发病的影响。方法选择2013年2月至2013年6月在华中科技大学附属同济医院生殖医学中心接受体外受精/胞装内单精子注射(IVF/ICSI)助孕治疗中,应用GnRH-a长方案降调(包括服用OC预处理及未服用OC预处理)的原发/继发不孕症患者共892例进行回顾性病例-对照研究。将研究对象按照基础窦卵泡计数(AFC)分为疑似高反应组(AFC≥20个)和非疑似高反应组(AFC<20个)。分别对这两部分人群OC预处理情况、降调节-促排卵结局、OHSS发病情况进行分析。结果对于疑似高反应IVF/ICSI患者降调节前使用OC进行预处理可降低降调后血清E2、LH水平(30.1±13.6比26.1±11.1,P<0.05;1.5±0.7比1.3±0.6,P<0.05),并且降低LH/FSH比值(0.5±0.2比0.4±0.2,P<0.05),适度增加降调深度,降低这部分患者的采卵日E2水平(8065.9±3442.6比6591.9±2940.2,P<0.05)、获卵数(19.4±7.6比17±7.8,P<0.05)。未行OC预处理组早发OHSS有54例(43.2%),晚发OHSS有13例(10.4%),OC预处理组(共102例)中早发OHSS有30例(29.4%),晚发OHSS有2例(2%)。两组OHSS发生率差异有显著性(P<0.05)。两组重度OHSS发病率(12%比3.9%)、住院天数(12天比9.3天)差异有显著性(P<0.05)。对于非疑似高反应人群使用OC预处理后降调节-促排卵结局各项指标及OHSS发生相关指标差异均无显著性。结论疑似高反应人群降调前服用OC预处理可适度降低卵巢反应性,优化LH/FSH比值,降低采卵日E2、采卵前大卵泡数、获卵数,降低OHSS发生风险。非疑似高反应人群降调前服用OC预处理对OHSS发病率无显著影响。

Objectives To study whether a cycle of oral contraceptives before pituitary down- regulation could reduce the morbidity of ovarian hyperstimulation syndrome of different population after COH(controlled ovarian hyperstimulation). Methods Data of 892 IVF /ICSI cycles with long GnRH- a scheme of pituitary down- regulation in luteal phase were collected from Feb. 2013 to Jun. 2013 in our reproductive center. We conducted a retrospective case- control study. The object of study was divided by antral follicular count into two groups of population,namely suspected high responders and non- suspected high responders. We compared the outcome of controlled ovarian hyperstimulation and the morbidity of ovarian hyperstimulaiton syndromebetween patients with or without oral contraceptives pretreatment. Results As for the suspected high responders,oral contraceptives pretreatment could reduce the serum E2 level(30. 1 ± 13. 6 vs 26. 1 ±11. 1,P < 0. 05),serum LH level(1. 5 ± 0. 7 vs 1. 3 ± 0. 6,P < 0. 05),LH /FSH ratio(0. 5 ± 0. 2 vs 0. 4± 0. 2,P < 0. 05) and also reduce the serum E2 level on the ovarian puncture day(8065. 9 ± 3442. 6 vs6591. 9 ± 2940. 2,P < 0. 05) and number of oocytes retrieved(19. 4 ± 7. 6 vs 17 ± 7. 8,P < 0. 05). The OHSS morbidity is also significantly reduced( 53. 6% vs 31. 4%). As for the non- suspected high responders,OC pretreatment seems to have no effect on the COH outcome and the OHSS morbidity.Conclusion Of the suspected high responders,oral contraceptives pretreatment could suppress the high ovarian respond to a certain degree,which could reduce the LH /FSH ratio,serum E2 on the ovarian puncture day,follicular count before ovarian puncture and the number of oocytes retrieved. Thus,it could reduce the morbidity of ovarian hyperstimulaiton syndrome. Such effect of oral contraceptives was not found in terms of the non- suspected high responders in IVF /ICSI procedure.