多囊卵巢综合征患者超排卵过程中行卵泡抽吸的效果观察

Outcome of follicular aspiration of selection phase in patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation

目的 观察多囊卵巢综合征(PCOS)患者于行体外受精-胚胎移植(IVF-ET)的超排卵过程中抽吸卵泡的结局。方法 对13例首次行IVF-ET(对照周期)失败、发生卵巢过度刺激征(OHSS)的PCOS不孕患者,于再次行IVF—ET(卵泡抽吸周期)的超排卵过程中,在B超指引下经阴道对苴径9～10 mm的卵泡进行穿刺抽吸,保留直径9～10 mm卵泡≤10个。卵泡抽吸后继续进行超排卵方案。比较两个周期患者血清性激素水平变化及卵子发育等情况。结果 卵泡抽吸周期hCG注射日平均直径≥12 mm的卵泡数为(16±4)个,较对照周期(29±8)个明显减少,两个周期比较,差异有极显著性(P<0.001);卵泡抽吸周期平均血清雌二醇水平为(9899±1430)pmol/L,较对照周期(15 545±1767)pmoL/L明显降低,两个周期比较,差异有极显著性(P<0.001)。卵泡抽吸周期中,无患者发生中、重度OHSS;对照周期中,9例(9/13,69％)患者发生OHSS。卵子回收率、成熟率、受精率、卵裂率及胚胎种植率均显著高于对照周期。结论 于行IVF—ET的超排卵过程中,抽吸直径为9-10 mm的卵泡,能有效减少PCOS不孕患者hCG注射日的优势卵泡数目,降低血清雌二醇水平,减少中、重度OHSS的发生。

Objective To assess the effectiveness of follicular aspiration in selection phase of follicle growth of the patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization-embryo transfer(IVF-ET). Methods Thirteen infertile patients with PCOS who previously failed IVF-ET associated with ovarian hyperstimulation syndrome (OHSS) , served as control group, were asked to undergo new IVF cycles (follicular aspiration group) with ultrasound-guided transvaginal follicular aspirations in the selection phase ( diameter9 - 10 mm) of follicle growth,with a total of 13 cycles both. No more than 10 follicles were selected. Clinical and endocrinological parameters were monitored. Results In follicular aspiration group, the average number of follicle 5; 12 mm in diameter and serum estradiol level were 16 ± 4 and (9899 ± 1431) pmol/L respectively, which were significantly lower than 29 ± 8 ( P < 0. 001) and (15 544 ± 1767) pmol/L( P < 0. 001 ) in control group. No moderate-severe OHSS occurred in follicular aspiration group, while 9 out of 13 (69 % ) occurred in control group. Oocyte retrieval rate, maturation rate, fertilization rate and cleavage rate in follicular aspiration group were greatly higher than those in control group. Conclusions Follicularaspiration in selection phase of follicle growth associates with reduced dominant follicle numbers and estradiol level on the day of hCG injection and moderate-severe OHSS incidence in patients with PCOS undergoing IVF-ET.