多囊卵巢综合征患者体外受精-胚胎移植后的妊娠结局

Pregnancy outcomes of patients with polycystic ovary syndrome undergoing in vitro fertilization and embryo transfer

目的分析多囊卵巢综合征（PCOS）患者体外受精．胚胎移植（IVF·ET）后的妊娠结局，及不同表型PCOS患者妊娠结局的差异。方法选取2005年1月至2010年2月在山东大学附属省立医院生殖医学中心行IVF-ET治疗的PCOS患者631例（PCOS组），按照年龄与孕前体质指数（BMI）配对选择输卵管性不孕患者1423例作为对照组。对两组患者的临床资料进行回顾性分析，比较两组患者IVF-ET治疗后的流产率和单胎妊娠结局。结果PCOS组和对照组患者IVF-ET后流产率分别为22．7％（143／631）和18．69％（266／1423），两组比较，差异有统计学意义（P〈0．05）。PCOS组和对照组孕单胎例数分别为339例和794例，两组单胎妊娠结局为：PCOS组和对照组早产率分别为11．2％（38／339）和6．4％（51／794），两组比较，差异有统计学意义（P〈0．05）；妊娠期糖尿病发生率分别为1．5％（5／339）和0．6％（5／794）、妊娠期高血压疾病发生率分别为4．7％（16／339）和3．0％（24／794）、妊娠天数分别为（272±13）d和（273±10）d、新生儿畸形率分别为0．6％（2／339）和0．8％（6／794）、足月新生儿出生体质量均为（3．54-0．5）b，以上各项两组比较，差异均无统计学意义（P〉0．05）。PCOS组中规律排卵患者流产率及单胎早产率分别为18．6％（19／102）和8．2％（4／49），与对照组分别比较，差异均无统计学意义（P均〉0．05）；稀发排卵患者流产率及单胎早产率分别为23．4％（124／529）和11．7％（34／290），与对照组比较，差异有统计学意义（P〈0．05）。结论PCOS患者行IVF—ET治疗后流产率、早产率增加，但PCOS患者中规律排卵型患者各种并发症发生率未升高。

Objectives To study pregnant outcomes of patients with polycystic ovary syndrome （PCOS） undergoing in vitro fertilization and embryo transfer （IVF-ET）, and analyze the differences of pregnant outcomes in patients with various phenotypes of PCOS. Methods From Jan. 2005 to Feb. 2010, 631 PCOS patients（PCOS group）and 1423 patients with tubal infertility （control group） who underwent IVF-ET with matched age and body mass index were selected in Center for Reproductive Medicine of the Provincial Hospital Affiliated to Shandong University. Retrospective study was carried out, and pregnancy outcomes were compared between two groups. Results The rates of abortion and preterm birth in PCOS group were significantly higher than those in control group [22. 7% （143/631） vs. 18.69% （266/1423） and 11.2% （38/339） vs. 6.4% （51/794） respectively, all P 〈 0. 05 ]. The rates of gestational diabetes mellitus were 1.5% （5/339） in PCOS and 0. 6% （5/794） in control group, respectively; the rates of pregnancy induced hypertension syndrome were 4. 7a/o （16/339） in PCOS and 3. OV/o （24/794） in control group; gestational days were（272 _＋ 13）days in PCOS and（273 ＋ 10）days in control group; the rates of neonatal deformity were O. 6% （2/339） in PCOS and 0. 8% （6/794） in control group; weight of newbornthe above index （ all P 〉 0. 05 ）. Ovulatory PCOS patients had similar abortion rate [ 18.6% （19/102） ] and preterm birth rate [8.2% （4/49） ] when compared with those of control group （ P 〉 O. 05 ）. Conversely, oligo-ovulatory PCOS patients showed higher abortion rate [ 23.4% （ 124/529 ） ~ and preterm birth rate [ 11.7% （34/290） ] than those of control group （ P 〈 0. 05 ）. Conclusions PCOS patients after IVF-ET have an increased abortion rate and preterm birth rate. However, ovulatory PCOS did not present various pregnancy complications. Non-polycystic ovary PCOS patients have worse pregnancy outcome. Ovarian dysfunction might be related to obstetric complications.