体外受精-胚胎移植中不同方案治疗多囊卵巢综合征不孕患者的疗效比较

Study on clinical effect of different protocols in infertility women with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer

目的比较未成熟卵母细胞体外成熟培养(IVM)、拮抗剂方案、口服避孕药(OC)双重抑制方案和卵泡期长方案治疗多囊卵巢综合征(PCOS)不孕症患者的结局。方法回顾性分析2011年1月至2012年10月在本中心接受辅助生殖技术治疗的PCOS不孕患者,共413例458个周期,分别采用IVM(IVM组,95个周期),拮抗剂方案(拮抗剂组,53个周期),OC双重抑制方案(OC组,278个周期)和卵泡期长方案(卵泡期长方案组,32个周期)治疗,比较各组的实验室结果和临床结局。结果 IVM组未用促性腺激素(Gn),拮抗剂组Gn用量为(1,297.17±398.88)U,明显低于OC组[(1,451.7±497.80)U],差异有统计学意义(P<0.05)。IVM组、拮抗剂组、OC组和卵泡期组的临床妊娠率分别为33.7%、54.5%、61.1%和55.2%,IVM组低于其他各组,差异均具统计学意义(P<0.05),其他三组间比较差异无统计学意义(P>0.05)。IVM组未发生卵巢过度刺激综合征(OHSS);拮抗剂组未发生重度OHSS;拮抗剂组、OC组及卵泡期组的OHSS发生率分别为13.2%、20.7%及18.8%,差异无统计学意义(P>0.05)。结论拮抗剂方案Gn用量显著低于OC双重抑制方案,OHSS发生率相对较低,而临床妊娠率显著高于IVM组,是PCOS不孕患者较为适宜的治疗方案。

Objective： To compare clinical and laboratory outcomes of in vitro maturation （IVM）, gonadotropin- releasing hormone （GnRH） antagonist protocol,dual suppression protocol using oral contraceptives （OC） GnRH agonist, and early follicular initiation protocol with GnRH agonist in infertile women with polycystic ovary syndrome （PCOS）. Methods： A total of 413 infertile patients with PCOS underwent 458 IVF cycles in the First Affiliated Hospital of Wenzhou Medical College from January 2011 to December 2012 and their data were analyzed retrospectively. They were divided into 4 groups according to different protocols, namely IVM group （group A, 95 cycles）, GnRH antagonist protocol group （group B, 53 cycles）, OC and GnRH agonist protocol group （group C, 278 cycles） and early follicular initiation protocol with GnRH agonist group （group D,32 cycles）. The laboratory and clinical results were compared among them. Results： No gonadotropin was used in the group A. The mean dosage of gonadotropin administrated was statistically different between group B and group C, which was （1,297. 17±398. 88） U and （1,503. 9± 507. 63） U respectively （P（0.05）. Clinical pregnancy rate per transfer in group A, group B, group C and group D were 33.7% ,54.5% ,61.1% and 55.2% respectively,which was significantly lower in group A than that of other three groups （P（0.05）. There were no significant differences among other three groups （P〉0.05）. No ovary hyperstimulation syndrome （OHSS） was found in group A and no severe OHSS was found in group B and group D. Incidence of OHSS in group A,gr0uo PB,group C and group D were 0%, 13.2%, 20.7% ,and 18.8% respectively. Conclusions. This study demonstrated that the GnRH antagonist protocol was associated with a similar clinical pregnancy rate without incidence of severe OHSS,and requiring lower gonadotrophin dosage compared with dual suppression protocol and GnRH agonist follicular initiation protocol. The GnRH antagonist protocol obtains much higher clinical pregnancy rate than IVM protocol, it might be the treatment choice for patients with PCOS undergoing IVF.