不同胰岛素抵抗水平的多囊卵巢综合征患者体外受精-胚胎移植临床结果的分析

Analysis of IVF-ET outcomes in patients with polycystic ovarian syndrome with different level of Insulin resistance

目的分析多囊卵巢综合征(PCOS)患者进行体外受精-胚胎移植(IVF-ET)时,其胰岛素抵抗水平与临床结果的关系。方法选择PCOS患者60例为实验组,月经周期规则的输卵管性不孕患者50例为对照组。PCOS组内,以稳态模型评价指数(HOMA-IR)的中位数(3.37)为标准,将PCOS患者分为高HOMA-IR组(30例)和低HOMA-IR组(30例)。三组患者均采用口服避孕药(OC)处理后的黄体期长方案进行体外受精-胚胎移植(IVF-ET),比较各组间体重指数、基础窦卵泡数、基础性激素水平、Gn的用量、获卵率、受精率、优质胚胎率、着床率、妊娠率、流产率及继续妊娠率与胰岛素抵抗水平的关系。结果三组患者获卵率、优质胚胎率、着床率和妊娠率差异均无统计学意义(P>0.05)。PCOS组基础窦状卵泡数、获卵数多于对照组、Gn的用量少于对照组,受精率和继续妊娠率低于对照组,流产率高于对照组,差异有统计学意义(P<0.05)。高HOMA-IR组基础窦状卵泡数多于低HOMA-IR组、Gn的用量少于低HOMA-IR组,受精率低于低HOMA-IR组,流产率高于低HOMA-IR组,继续妊娠率低于低HOMA-IR组,差异均有统计学意义(P<0.05)。结论胰岛素抵抗水平是PCOS患者进行IVF-ET后妊娠结局产生的重要因素。

Objective：To analyze the relationship between the level of insulin resistance and the in vitro fertilization-embryo transfer（IVF-ET）outcomes in patients with polycystic ovarian syndrome（PCOS）.Methods：Sixty women diagnosed as PCOS were enrolled as experimental group,and 50 infertile cases with tubal factor and regular menstruation were served as control group.In PCOS group,Based on the median of homeostasis model assessment insulin resistance（HOMA-IR）index,total 60 patients with PCOS were divided into higher HOMA-IR group（n=30）and lower HOMA-IR group（n=30）.All the subjects received treatment with long luteal-phase down-regulations and controlled ovarian hyperstimulation protocol in IVF cycles,and their clinical characteristics were analyzed.Results：The three groups showed no significant differences in oocyte retrieval rate,rate of high-quality rembryos,implantation rate and pregnancy rate（P〈0.05）.PCOS group had a significantly greater number of antral follicles and recovery number of oocytes,a significantly lower total gonadotropin dose,implantation rate and ongoing pregnancy rate,a significantly greater abortion rate than the control group（P〈0.05）.The higher HOMA-IR group had a significantly greater number of antral follicles,a significantly lower total gonadotropin dose and implantation rate,a significantly greater abortion rate and a significantly lower ongoing pregnancy rate than the lower HOMA-IR group（P〈0.05）.Conclusion：The level of insulin resistance is a significnt factor in the IVF-ET outcomes in patients with PCOS.