GnRHa联合低剂量hCG扳机在高反应多囊卵巢综合征患者体外受精中的应用

GnRHa combined with low dose hCG trigger in in vitro fertilization treatment of polycystic ovary syndrome high responders

目的探讨多囊卵巢综合征(PCOS)高反应患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗使用低剂量联合扳机的安全性和有效性。方法回顾性队列分析2014年1月1日—2015年12月31日期间在本院生殖医学中心采取促性腺激素释放激素拮抗剂(GnRH-A)方案进行控制性促排卵行IVF/ICSI助孕的PCOS患者(n=364)的临床资料,分为低剂量联合扳机组(GnRH-A+低剂量hCG,A组,n=127)和标准扳机组(hCG,B组,n=237)。分析比较因卵巢高反应采用不同扳机方案患者的临床资料。结果患者一般情况和促排卵治疗用药组间均无统计学差异(P>0.05)。A组患者hCG扳机日血清E_2水平[(19193.9±7837.5)pmol/L]及获卵数(29±9)均显著高于B组患者[(15786.8±7104.1)pmol/L,P<0.05;24±6,P<0.05]。两组患者的ICSI授精率、M_Ⅱ卵比率及双原核(2PN)胚胎率均无统计学差异(P>0.05)。A组患者冻存胚胎数(14±6)显著多于B组患者(12±5,P<0.05)。中重度卵巢过度刺激综合征(OHSS)发生率无统计学差异(P>0.05)。冻融移植周期A组患者胚胎复苏率(62.3%)显著低于B组(77.0%,P<0.05)。两组患者的移植胚胎数、临床妊娠率、着床率、流产率及活产率均无统计学差异(P>0.05)。结论对于高反应PCOS患者使用拮抗剂方案基础上,应用减量联合扳机并全部胚胎冻存,不增加重度OHSS发生率,冻融胚胎移植周期也得到了满意的治疗结局。

Objective To investigate the effectiveness and safety of low dose human chorionic gonadotropin（hCG） dual trigger in polycystic ovary syndrome（PCOS） high-responders who underwent in vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）. Methods This was a retrospective cohort study. There were 364 infertile patients with PCOS high-responders accepted IVF/ICSI treatment in Reproductive Medical Center of Peking University, between Jan. 1st 2014 and Dec. 31st 2015, with GnRH antagonist flexible protocol. The patients were divided into two groups depending on different trigger protocols. Group A was low dose hCG dual trigger group（n=127）, while group B was standard trigger group（n=237）. The general characteristics and treatment outcomes were compared between two groups. Results There were no significant differences between the two groups refer to general characteristics, and Gn used dosage（P〉0.05）. The serum E2 level on hCG trigger day [（19193.9 ±7837.5） pmol/L]and mean number of oocyte retrieved（29 ± 9） in group A were significantly higher than those in group B [（15786.8 ±7104.1） pmol/L,P〈0.05; 24 ±6, P〈0.05]. The ICSI rate, MⅡ oocyte rate and 2 pronuclear（2 PN） embryo rate were comparable of two groups（P〉0.05）.The number of frozen embryos were significantly higher in group A（14 ± 6） than that in group B（12 ±5, P〈0.05）. The severe ovarian hyperstimulation syndrome（OHSS） rate was comparable in two groups（P〉0.05）. In frozen-thawed cycles, the embryo survival rate was significantly lower in group A（62.3%） than in group B（77.0%, P〈0.05）. The number of transferred embryos, clinical pregnancy rate, implantation rate, miscarriage rate and live birth rate were comparable in the two groups（P〉0.05）. Conclusion For high responders of PCOS patients, besides of GnRH antagonist protocol, using low dose hCG dual trigger and freeze all protocol, will not increase the incidence of OHSS. Furthermore, the frozen-thawed cycles will get satisfied treatment outcomes.