多囊卵巢综合征患者控制性促排卵策略研究进展

Progress in Controlled Ovarian Stimulation Protocols of Polycystic Ovary Syndrome

多囊卵巢综合征(PCOS)是临床常见的妇科内分泌紊乱综合征,是引起育龄期女性无排卵性不孕的主要原因。由于内分泌的紊乱,在体外受精-胚胎移植(IVF-ET)过程中,PCOS患者对药物的反应难以预测,控制性促排卵(COS)过程中极易出现卵巢反应不良、卵巢过度刺激综合征(OHSS)等现象。目前,PCOS患者IVF促排卵过程中常用的方案有长方案、拮抗剂方案、微刺激方案、改良超长方案、超长方案、未成熟卵母细胞体外培养成熟(IVM)等,其中长方案是多数生殖中心目前最常用的方案,微刺激方案和拮抗剂方案作为新的非降调节治疗策略,近年越来越受重视。改良超长方案及超长方案作为对传统方案的探索改进,在临床中也取得了一定的效果,而IVM作为一种新的技术,在简化治疗的同时显著降低了OHSS的发生。对PCOS不孕患者进行辅助生殖过程中,制定个体化治疗方案以获得优质卵子和胚胎,并避免OHSS等并发症的发生,是目前临床工作中需解决的关键问题。

Polycystic ovary syndrome（PCOS）,a common clinical endocrine disorder,is the main cause of anovulatory infertility in women of childbearing age. Due to the particular endocrine disorders in PCOS patients,it is hard to predict ovarian responses to drugs during controlled ovarian stimulation（COS）. So,poor ovarian responses and ovarian hyperstimulation syndrome（OHSS） are incredibly common. The common protocols used in IVF for PCOS patients include long protocol,antagonist protocol,mild stimulation protocol, revised super-long protocol,super-long protocol and in vitro maturation（IVM）. Presently,long protocol is most frequently used in most of reproductive centers. At the same time,antagonist protocol and mild stimulation protocol,as new protocols,are gradually favored by many clinicians. Super-long protocol and the revised super-long protocol,as the improved traditional protocols,have also obtained good clinic results. IVM,as a technical innovation, can simplify treatment and reduce the risk of OHSS. During IVF for patients with PCOS,it is the key point for clinicians to choose the optimal and economical treatment,to get high-quality eggs and embryos, and to avoid complications such as OHSS.