改良体外成熟培养——多囊卵巢综合征患者助孕治疗的有效替代方案

Modified in-vitro maturation—a effective and alternative protocol for treatment patients with polycystic ovary syndrome

目的比较多囊卵巢综合征(PCOS)患者三种助孕方案的治疗效果。方法回顾性分析2010年1月至2011年5月在本院助孕的PCOS患者,按接受的助孕方式分为三组:A组(n=97),自然周期卵母细胞体外成熟培养(IVM);B组(n=33),降调节后短暂促性腺激素(Gn)刺激再IVM;C组(n=112),长方案降调节后常规体外受精-胚胎移植(IVF-ET)助孕。比较三种助孕方案治疗效果。结果 B组和C组临床妊娠率无显著统计学差异(58.1%vs.57.7%,P>0.05),但均显著高于A组(32.5%)(P<0.05)。hCG日内膜厚度分别为A组(6.1±1.8)mm,B组(8.8±2.3)mm和C组(11.6±2.5)mm,三组间比较均有统计学差异(P<0.05)。A组未使用Gn,B组Gn用量为(578.1±314.4)IU,费用为(2,029.6士1204.8)元,C组Gn用量(1,751.1±692.8)IU,费用(5,768.4±2,100.8)元,三组比较均有统计学差异(P<0.05)。A、B组无卵巢过度刺激综合征(OHSS)发生,C组重度OHSS发生率为4.5%。结论 IVM助孕可以避免OHSS发生,若降调节后短暂Gn刺激再IVM助孕,由于子宫内膜发育得到改善,可以获得与长方案相似的临床妊娠率,是PCOS患者的一个经济安全有效的助孕方式选择。

Objective： To compare the effectiveness of three strategies of in in-vitro fertilization （IVF） for treatment of women with polycystic ovary syndrome （PCOS）. Methods： The clinical data of 242 patients with PCOS in our hospital from 2010 January to 2011 May were analyzed retrospectively. The patients were divided into three groups： 97 patients received in vitro maturation CIVM） in natural cycles （group A）, 33 patients received IVM after down regulation and shortly gonadotropin （Gn） stimulation （group B） and 112 patients received regular IVF after long-term protocol （group C）. Results： The clinical pregnancy rate in group B （58. 1%） and group C （57. 7%） were significant higher than that in group A （32.5%） （P〈0.05）. The endometrial thickness on hCG day in group A, B and C was （6.1±1.8）mm, （8.8±2.3）mm and （11.6±2.5）mm respectively, which showed significant differences between any two groups. Patients in group A did not receive Gn injection. In group B, Gn dosage was （578. 1± 314. 4） IU and overall cost for controlled ovary hyperstimulation （COH） was （2029. 6±1204. 8）RMB. In group C, Gn dosage was （1751. 1 ± 692. 8）IU and overall cost was （5768.4±2100.8）RMB. There were significant differences between any two groups （P〈0.05）. None of the patients in group A and group B occurred ovarian hyper-stimulation syndrome （OHSS）, the severe OHSS in group C was 4.5%. Conclusions： IVM after down regulation and short Gn stimulation is a safer and cost-effective protocol for treatment of patients with PCOS to prevent severe OHSS and improve pregnancy rate comparing to routine IVM.