体重对个体化控制性超排卵下ART结局的影响

Impact of weight on ART outcome by individualized controlled ovarian stimulation protocol

目的探讨患者体重对个体化控制性超排卵(COS)策略下辅助生殖技术(ART)治疗结局的影响。方法选择245个黄体中期长方案的体外受精(IVF)或卵胞浆内单精子注射(ICSI)周期,按世界卫生组织(WHO)亚洲人体重指数(BMI)标准分成正常体重组176例(BMI18.5～22.9kg/m2)及高BMI组69例(BMI≥23kg/m2),回顾性分析比较两组ART结局。结果高BMI组促性腺激素释放激素激动剂(GnRHa)用量(1.6±0.2)mg、促性腺激素(Gn)使用天数(12.4±3.6)d显著大于正常体重组[分别为(1.5±0.3)mg、(11.5±2.4)d],高BMI组HCG日平均雌二醇(E2)值(1883.6±1065.3)pg/mL、获卵率(69.8%)显著低于正常体重组[分别为(2525.7±1234.5)pg/mL、74.8%],两者比较,差异均有显著性(P<0.05);HCG日高BMI组子宫内膜厚度显著低于正常体重组(P<0.05),但其增厚内膜与菲薄内膜构成比在两组间差异无显著性(P>0.05);中重度卵巢过度刺激综合征(OHSS)发生率、获卵数、成熟卵子数/率、受精数/率、优质胚胎数/率、移植胚胎数、胚胎植入率、临床妊娠率及早期流产率,两组比较差异均无显著性(P>0.05)。结论在个体化COS策略下,高BMI可降低卵巢对Gn刺激的反应性,但不会影响ART治疗后早期妊娠结局。

【Objective】To assess the impact of weight on the outcome of assisted reproductive technology （ART） by individualized ovarian stimulation （COS） protocol. 【Methods】According to World Health Organization（WHO） body mass index （BMI） criteria for Asians, 245 in vitro fertilization （IVF） and intracytoplasmic sperm injection （ICSI） cycles using mid-luteal long gonadotropin releasing hormone agonist （GnRHa） protocols were divided into two groups by a cutoff of 24 kg/m2; normal weight （BMI 18.5-22.9 kg/m2; n =176 cycles） and overweight （BMI ≥23 kg/m2; n = 69 cycles）.【Results】Dose of GnRHa and days of ovarian stimulation were significantly higher in the overweight group （P 0.05）; the mean serum estradiol （E2） level on hCG day and the rate of retrieval oocytes were significantly lower in the overweight group （P 0.05）. Endometrial thickness on hCG day was significantly lower in the overweight group （P 0.05）, but for the proportion of thick and thin endometrium, there was no significant difference in the two groups （P 0.05）; the incidence of moderate-severe ovarian hyperstimulation syndrome （OHSS）, the number of retrieval oocytes, the number/rate of mature oocytes, the number/rate of fertilization, the mean number/rate of highquality embryos, the mean number of embryos transferred, implantation rate, clinical pregnancy rate and early pregnancy loss rate were comparable between the two groups（P0.05）.【Conclusion】Overweight may cause a lower stimulation response, but cannot affect early pregnancy outcome after ART treatment by individualized COS protocal.