腹腔镜卵巢打孔对多囊卵巢综合征患者体外受精结局的影响

Effect of laparoscopic ovarian drilling on IVF outcome in women with polycystic ovary syndrome

目的探讨腹腔镜卵巢打孔对多囊卵巢综合征(PCOS)患者体外受精(IVF)-胚胎移植结局的影响。方法回顾性分析行IVF治疗的213例PCOS患者临床资料,将患者按是否曾行腹腔镜卵巢打孔分为打孔组和非打孔组,同时选择因盆腔输卵管因素行IVF非PCOS的患者作为对照组,比较3组患者IVF的治疗结局。结果打孔组PCOS患者AFC、基础LH、LH/FSH较非打孔组显著降低(P<0.05),而基础FSH、T以及卵巢体积在打孔与非打孔组中差异无统计学意义(P>0.05)。在促排卵过程中,打孔组促性腺激素的使用总量[(1 923.80±733.64)IU]显著高于非打孔组[(1 679.10±589.18)IU](P<0.05)。3组患者获卵数及可利用胚胎数相当,打孔组临床妊娠率、持续妊娠率和种植率(58.49%、50.94%、36.21%)略高于非打孔组和对照组(55%、46.88%、34.38%和49.23%、42.31%、33.57%),但差异无统计学意义(P>0.05)。结论腹腔镜下卵巢打孔后患者的卵巢储备功能虽较非打孔PCOS患者低,但仍高于非PCOS患者。而对于打孔后未自然成功妊娠而行IVF助孕治疗的PCOS患者,打孔并不影响其妊娠成功率。

Objective To evaluate the effect of laparoscopic ovarian drilling （LOD） on IVF outcome in women with polycystic ovary syndrome （PCOS）. Methods Ovarian reserve and controlled ovarian stimulation for IVF were com- pared retrospectively in 343 women （213 of PCOS and 130 of non - PCOS） undergoing IVF in our unit from 2008 - 2011. Among them, 213 PCOS patients were divided in to two groups, Group A （received LOD before IVF, n =53） and Group B （received no surgical treatment, n = 160 ）. Results Basic AFC, serum LH and LH/FSH were significantly lower in Group A than those in Group B （ P 〈 0. 05 ）. During COH, significantly higher dose of gonadotropin was required in Group A （ 1 923.80 ± 733.64 IU） than that in Group B （ 1 679. 10 ±589. 18IU, P 〈 0. 05）. No significant difference was ob- served in oocytes retrieved and embryos available for transfer. Although the clinical pregnancy rate, ongoing pregnancy rate and implantation rate were higher in Group A （58.49% , 50. 94% and 36. 21% ） than in those in Group B and Group C（ 55% , 46. 88% , 34. 38% and 49.23%, 42. 31% , 33.57% ）, there was no significant difference among the three groups （ P 〉 0. 05 ）. Conclusion PCOS women with LOD have lower ovarian reserve than those without surgical treatment and controls. For women receiving IVF treatment, no influence of LOD is proved to the outcome of IVF.