摘要
目的:探讨微刺激促排卵方案在多囊卵巢综合征(PCOS)患者IVF中的应用。方法:将行IVF-ET的不孕患者分为3组:PCOS长方案组(A组,n=31)、PCOS微刺激组(B组,n=23)和非PCOS长方案对照组(C组,n=25)。比较3组的年龄、不孕年限、基础内分泌、口服避孕药后基础内分泌及IVF结局。结果:①年龄、不孕年限、基础FSH(bFSH)组间比较均无统计学差异(P>0.05);bLH、bLH/bFSH、bT在A组和B组中均明显高于C组(P<0.05);用口服避孕药后A组和B组LH、LH/FSH、T明显降低,使3组间内分泌比较无统计学差异(P>0.05)。②A组的受精率、卵裂率低于C组(P<0.05);Gn使用天数、获卵数、可利用胚胎数、优质胚胎数高于C组(P<0.05);Gn使用总量、种植率、临床妊娠率、流产率A、C组间比较均无统计学差异(P>0.05)。③B组受精率、卵裂率低于C组(P<0.05);Gn使用总量及Gn使用天数比C组明显减少(P<0.05);获卵数、可用胚胎数、优质胚胎数高于C组(P<0.05);B、C组间种植率、临床妊娠率、流产率比较无统计学差异(P>0.05)。④B组Gn使用总量及Gn使用天数比A组明显减少(P<0.05);B组获卵数、受精率、卵裂率、优质胚胎数、可利用胚胎数等指标与A组比较均无统计学差异(P>0.05)。⑤B组hCG注射日E2水平及移植日子宫内膜厚度明显低于A组(P<0.05),但种植率、临床妊娠率、流产率等方面与A组比较均无统计学差异(P>0.05)。结论:①口服避孕药在调整PCOS患者内分泌,降低PCOS患者LH、T方面有较好的作用,能改善PCOS患者内分泌环境;②PCOS患者行IVF时采用克罗米酚(CC)加hMG微刺激可降低hCG注射日E2水平,减少OHSS的发生。③CC加hMG微刺激方案对PCOS患者行IVF促排卵可能是相对经济、有效、安全的方法。
Objective: To explore the application of mild-stimulation protocal in IVF for polycystic ovarian syndrome(PCOS) patients.Methods: All the 79 infertile patients who underwent IVF were divided into 3 groups: the groups of long-term protocol(group A,n=31) and mild-stimulation protocol in polycystic ovarian syndrome patients(group B,n=23) and the control without PCOS(group C,n=25).The differences of age,duration of infertility,basal hormone levels of natural menstrual cycles,the cycles after taking in oral contraceptives and IVF/ICSI-ET outcome were compared among the 3 groups.Results: 1) The differences of age,duration of infertility,basal FSH level were not statistically significant among the 3 groups(P0.05).The levels of basal LH,LH/FSH and T were significanly higher in groups A and B than those in group C(P0.05).The levels of LH,LH/FSH,T in groups A and B decreased obviously after the use of oral contraceptives,but there were no significant differences among the 3 groups(P0.05).2) The fertilization rate and cleavage rate in group A were distinctly lower than those in group C(P0.05);Gn using days,the number of oocytes,available embryos and high quality embryos in group A were significantly higher than those in group C(P0.05);there were no significant differences in the total Gn,implantation rate,clinical pregnancy rate and abortion rate between groups A and C(P0.05).3) The fertilization rate,cleavage rate,total Gn and Gn using days in group B were distinctly lower than those in group C(P0.05);the number of oocytes,available embryos and high quality embryos in group B were significantly higher than those in group C(P0.05);there were no significant differences in implantation rate,clinical pregnancy rate and abortion rate between the two groups(P0.05).4) Total Gn and Gn using days in group B were distinctly lower than those in group A(P0.05);there were no significant differences in the number of oocytes,available embryos and high quality embryos between groups B and C(P0.05).5) E2 level,in hCG injection day and endometrial thickness in embyo transtation day in group B were distinctly lower than those in group A,but there were also no significant differences in the fertilization rate,cleavage rate,implantation rate,clinical pregnancy rate and abortion rate between the two groups(P0.05).Conclusions: 1) Pretreatment with oral contraceptives can adjust and improve the endocrine environment of PCOS patients through lowering their LH and androgen levels.2) Mild-stimulation protocal in IVF for polycystic ovarian syndrome patient may lower E2 level in hCG injection day and reduce the incidence of OHSS.3) Mild-stimulation protocol with clomiphene citrate and hMG may be economic,effective and safe for controlled ovarian hyperstimulation in IVF cycles for PCOS patients.
出处
《生殖与避孕》
CAS
CSCD
北大核心
2011年第9期635-639,共5页
Reproduction and Contraception