促性腺激素在多囊卵巢综合征患者体外受精-胚胎移植治疗中的应用探讨

The application of gonadotropin in in vitro fertilization-embryo transfer treatment of the infertile patients with polycystic ovarian syndrome

目的探讨促性腺激素(Gn)在多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子注射(ICSI)治疗中的种类及剂量应用方案。方法回顾性分析2004年7月至2008年6月我院生殖中心收治PCOS患者的IVF-ET或ICSI治疗周期238个。根据Gn使用不同分为重组人卵泡刺激素(r-FSH)组和r-FSH+人绝经期促性腺激素(HMG)组,比较两组血清激素水平、卵巢反应性和治疗结局相关指标。根据卵巢过度刺激征(OHSS)发生程度分组,比较各组间获卵数、Gn用量和时间。结果r-FSH+HMG组Gn用量及时间显著高于r-FSH组。两组人绒毛膜促性腺激素(hCG)注射日血清黄体生成素(LH)、雌二醇(E_2)水平,获卵数、卵子成熟率、受精率、卵裂率、优质胚胎数经t检验均无统计学差异。两组临床妊娠率、流产率、OHSS发生率、因OHSS致移植取消率经卡方检验均无统计学差异。获卵数Ⅱ、Ⅲ度OHSS组间无显著差异,但均显著高于Ⅰ度和未发生OHSS组。OHSS各组间Gn用量、时间经方差分析无统计学差异。结论对使用FSH后卵巢反应欠佳的PCOS患者,加用HMG是一种有效且安全的超促排卵方案。PCOS患者预防OHSS发生在于个体化的促排卵方案和严密监测。

Objective. To evaluate the application of gonadotropin in in vitro fertilization-embryo transfer （IVF-ET） or intracytoplasmic sperm injection （ICSI） treatment of the infertile patients with polycystic ovarian syndrome （PCOS）. Methods： A retrospective analysis was performed on 238 IVF-ET or ICSI cycles which were carried out from July 2004 to June 2008 in our center. Patients were divided into r-FSH group （A） and r-FSHq- HMG group （B） according to the gonadotropin used. The levels of serum Ez, LH on the day of hCG injec- tion, the number of retrieved oocytes and mature oocytes, the rates of fertilization, cleavage, high-class embryo, clinical pregnancy and miscarriage, the incidence of ovarian hyperstimulation syndrome （OHSS） and cancellation rate of ET were compared between the two groups. In addition, the duration of stimulation and the amps of gonadotropin were compared between the OHSS patients and normal response patients. Results： The duration of stimulation and the amps of gonadotropin were significantly higher in r-FSH ＋HMG group. The levels of serum E2 and LH on the day of hCG injection were not statistically different between the two groups. There was no significantly difference in the number of retrieved oocytes and mature oocytes, the rates of fertilization, cleavage, high-class embryo, clinical pregnancy and miscarriage, the occurrence of OHSS and cancelled cycle between the two groups. Moreover, there was no significantly difference in the duration of stimulation and the amps of gonadotropin between the OHSS and normal response patients. Conclusions： As for the patients with PCOS who have the low ovarian response during the r-FSH stimulation, the additional use of HMG seems to be an effective and safe treatment. The occurrence of OHSS can not be predicted by the amps of gonadotropin, but can be controlled by individualized protocol and strict supervision.