体重指数对多囊卵巢综合征患者IVF/ICSI-ET助孕结局的影响

Impact of body mass index on outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer in patients with polycystic ovary syndrome

目的探讨体重指数(BMI)对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者常规体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的影响。方法回顾性分析2015年1月至2017年7月在郑州大学第二附属医院生殖中心行长方案IVF/ICSI-ET治疗的1381例PCOS患者,根据BMI分为4组:A组(低体重组,BMI<18.5);B组(正常体重组,18.5≤BMI<23.9);C组(超重组,24≤BMI<27.9);D组(肥胖组,BMI≥28)。分别比较各组相关指标和妊娠结局。结果 D组促排周期取消率高于B组(2.78%vs.0.30%,P<0.001),D组与C组促性腺激素(gonadotropin,Gn)总量和时间显著多于B组与A组(P<0.001),D组胚胎种植率(24.04%)与临床妊娠率(36.27%)明显低于A、B和C组(P<0.01);D组活产率(26.44%)明显低于B与C组(P<0.01);B组h CG注射日血清雌二醇(estradiol,E2)浓度最高,获卵数最多(P<0.001),4组间受精率、卵裂率、优质胚胎率、流产率差异无统计学意义(P>0.05)。结论随着BMI升高,PCOS患者IVF/ICSI-ET助孕过程中Gn使用时间延长、用量增加。体重低于或高于正常者获卵数减少。PCOS伴有肥胖者行IVF/ICSI-ET的胚胎种植率、临床妊娠率及活产率降低,对妊娠结局产生负面影响。

Objective To explore the influence of body mass index （BMI） on outcomes of in vitro fertilization/intracyto- plasmic sperm injection-embryo transfer （IVF/ICSI-ET）techniques in patients with polycystic ovary syndrome （PCOS）. Methods We retrospectively analyzed 1381 patients with PCOS treated with IVF/ICSI-ET, of whom controlled ovarian stimulation were performed with long protocol, from January 2015 to July 2017 in the Second Affiliated Hospital of Zhengzhou University.Patients were divided according to BMI ： group A （underweight, 〈 18.5）, group B （normal, 18.5- 〈 23.9）, group C （overweight, 24- 〈 27.9） , and group D （obese, ≥28）.The related indicators and clinical outcomes were compared among four groups.Results We observed that the ovarian stimulation cancellation rate of group D was higher than that of group B（2.78% vs. 0.30%,P 〈 0.001）.It showed that group D and group C required more dose of gonadotropin and longer time than group B and group A （P 〈 0.001 ）. The implantation rate （24.04%）and clinical pregnancy rate （36.27%） of group D were lower than group A, B, and C （P 〈 0.01 ）.Besides, the live birth rate in group D （26.44%） was significantly lower than that in groups B and C （P 〈 0.01 ）.Additionally, group B had the highest estradiol level and the number of oocytes retrieved was the highest, too（P 〈 0.001 ）.There was no difference in the rate of fertilization, cleavage, embryo quality or miscarriage rate among the four groups （P 〉 0.05）.Conclusion As BMI increases, higher total dose and duration of gonadotropin are required.Abnormal weight reduces the number of eggs.PCOS patients with obesity receiving IVF/ICSI have lower implantation rate, clinical pregnancy rate and live birth rate, which has negative impact on clinical outcomes.