多囊卵巢综合征患者IVF治疗中超促排卵方案的对比研究

Comparative Study of Ovarian Superovulation Protocols in IVF Therapy for Polycystic Ovary Syndrome

目的:探讨不同的超排卵方案对多囊卵巢综合征(PCOS)患者实施IVF-ET治疗过程的影响。方法:回顾分析行IVF治疗、长方案超促排卵的PCOS患者134个移植周期,比较分析不同超促排卵方案、促排卵药物的IVF-ET结局。结果:①递增方案组(n=7,6)总Gn使用量明显大于递减方案组(n=74)、Coasting方案组(n=16)和恒量方案组(n=18)(P<0.05)。②后期添加hMG组(n=61)总Gn使用量明显大于单用FSH组(n=73)(P<0.05),着床率也明显降低(P<0.05),但临床妊娠率无显著性差异(P=0.064);③普丽康组(n=43)与果纳芬+hMG组(n=22)及普丽康+hMG组(n=39)相比,总Gn使用量明显减少(P<0.05),而与果纳芬组(n=30)间无统计学差异;普丽康组与普丽康+hMG组相比,获卵数明显增加(P<0.05)。结论:PCOS患者的长方案超排卵方案中,递增方案增加了Gn使用总量而临床妊娠率有偏低的趋势;添加hMG不能提高着床率和临床妊娠率;单纯普丽康超排卵有减少总Gn使用量,增加获卵数的趋势。

Objective：To investigate the effect of different kinds of hyperstimulation protocol for patients with polycystic ovary syndrome（PCOS） in the process of in vitro fertilization treatment.Methods：A total of 134 IVF-ET cycles of patients with PCOS using long protocol were selected.Compare the differences of total treatment time,total doses of Gn,the number of oocytes,MII oocytes rate,can-be-transferred embryos rate,implantation rate,clinical pregnancy rate,abortion rate and the incidence of moderate and severe ovarian hyperstimulation syndrome（OHSS）.Results：1） The total dose of Gn in incremental protocol（n=76） was higher than that in degressive protocol（n=74）,coasting protocol（n=16）,constant protocol（n=18）,respectively（P0.05）;2） The total dose of Gn in superovulation using FSH added hMG later（n=61） was increased significantly than that in the protocol which using FSH only（n=73）（P0.05）,and the implantation rate is lower significant（P0.05）,clinical pregnancy rate is no significant（P=0.064）;3） To compare with three groups of Gonal-F（n=30）、Gonal-F ＋ hMG（n=22）,and Puregon ＋ hMG（n=39）,the total Gn decrease significantly in Puregon group（n=43）（P0.05）;and the number of oocytes in Puregon group significantly increased compared to Puregon ＋ hMG group（P0.05）.Conclusion：In the incremental protocol,the total doses of Gn is higer but clinical pregnancy rate is going to be lower;Adding hMG later for PCOS patients can not increase the rate of implantation and clinical pregnancy;Using Puregon only for ovarian hyperstimulation seems can reduce the the total doses of Gn and increase the the number of oocytes.