限制性促排卵方案预防卵巢过度刺激综合征的探索性研究

Research on the protocol of limited ovarian stimulation to prevent ovarian hyperstimulation syndrome

目的研究提前注射绒促性素（hCG）的促排卵方案，即限制性促排卵（LOS）方案，在预防卵巢过度刺激综合征（OHSS）发生中的作用。方法对10例OHSS高危的不孕患者，其中8例为多囊卵巢综合征（PCOS）患者，采用促性腺激素释放激素激动剂（GnRHa）长方案超排卵，当最大卵泡直径达到12．0～14．5mm时注射hCG10000U，36h后取卵，行常规体外受精或单精子卵母细胞质内注射及胚胎移植。结果10例患者均无OHSS发生，获卵11～35个，其中成熟卵4～28个，均在取卵周期行胚胎移植。胚胎移植后妊娠8例，其中输卵管妊娠1例。结论LOS方案可以使PCOS不孕患者在获得足够多的成熟卵、有效防止OHSS发生的同时不降低妊娠率。

Objective To investigate whether the limited ovarian stimulation （ LOS ） could avoid the severe ovarian hyperstimulation syndrome （OHSS） in patients with high risk of OHSS. Methods Ten infertile patients were diagnosed as polycystic ovarian syndrome（PCOS） with high risk of OHSS. All of them were arranged LOS cycles, a long-induction protocol using gonadotropin releasing hormone agonist （GnRHa） for controlled ovarian hyperstimulation. A full dose of human chorionic gonadotropin （10 000 U ） was administered when the leading follicle reached a mean diameter of 12. 0 - 14. 5 mm. Oocytes were retrieved 36 hours later, followed by conventional in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） and embryo transfer. Results Ten patients produced 11 -35 oocytes, including 4 -28 oocytes of metaphase Ⅱ. Embryos were transferred in all of ten patients and eight clinical pregnancies were diagnosed. Unfortunately, ectopic pregnancy occurred in one of the patients. None of them experienced the symptoms of OHSS. Conclusions LOS may play a valuable role in preventing OHSS and achieving enough mature oocytes for the patients of PCOS. Furthermore, this protocol would not reduce the pregnancy rate of the patients.