拮抗剂方案与标准长方案用于多囊卵巢综合征患者体外受精-胚胎移植妊娠结果分析

Comparison of Two Protocols in Infertile Patients with PCOS Underwent in Vitro Fertilization-Embryo Transfer Cycles

目的:比较多囊卵巢综合征(PCOS)患者行体外受精-胚胎移植(IVF-ET)时,应用促性腺激素释放激素拮抗剂(Gn RHA)方案和标准长方案促排卵的效果,以寻求更为灵活方便且并发症少的促排卵方案。方法:回顾分析2015年1月—2017年9月于大连市妇女儿童医疗中心就诊的PCOS患者的IVF助孕资料,按照促排卵方案分为2组:拮抗剂组90周期,标准长方案组150周期,比较2组的促性腺激素(Gn)用药时间、取卵数、2原核(2PN)数、2PN受精率、可利用胚胎数、优质胚胎数、移植1次妊娠率(包括新鲜和解冻移植)及卵巢过度刺激综合征(OHSS)发生率。结果:拮抗剂组Gn用药时间少于标准长方案组,差异有统计学意义(Z=-11.230,P=0.000)。2组患者2PN数、可利用胚胎数、2PN受精率和优质胚胎数比较,差异无统计学意义(均P>0.05)。移植1次后2组临床妊娠率差异无统计学意义。标准长方案组发生11例中重度OHSS,拮抗剂组发生1例重度OHSS,标准长方案组中重度OHSS发生率高于拮抗剂组,差异有统计学意义(χ~2=4.340,P=0.037)。结论:对于PCOS患者,标准长方案组和拮抗剂组移植1次妊娠率相似,拮抗剂组中重度OHSS发生率低。拮抗剂组不用降调节,减少患者的经济压力且妊娠率与经典的标准长方案相似。因此对于PCOS患者,可尝试选用拮抗剂方案配合冷冻胚胎后解冻移植,不降低妊娠率且并发症少。

Objective：To compare the clinical outcomes of two protocols,the classical gonadotropin releasing hormone antagonist （GnRHA） protocol and the new GnRH agonist （GnRHa） long protocol,in those infertile patients with PCOS underwent in vitro fertilization-embryo transfer （IVF-ET） cycles,in order to explore the feasibility protocol with fewer complications.Methods：The infertile women with PCOS underwent IVF-ET in our center from January 2015 to September 2017 were respectively analyzed.A total of 240 cycles were divided into the GnRHA protocol group （GnRHA group,90 cycles） and the GnRHa long protocol group （GnRHa group,150 cycles）.The clinical outcomes were compared between the two groups,including the gonadotropin duration,the number of retrieved oocyte,the number of 2PN fertilized egg,the fertilization rate,the number of usable embryos,the number of good quality embryos,the pregnancy rate of once ET and the rate of ovarian hyperstimulation syndrome （OHSS）.Results：The day of drug-use of the GnRHA group was lower than that of the GnRHa group （Z=-11.230,P=0.000）.There were no statistical differences in the number of 2PN fertilized egg,the fertilization rate,the number of usable embryos and the number of good quality embryos （both P＞0.05）.The difference in the pregnancy rate of once ET （including fresh and thawed transplants） between the two groups was not significant （P＞0.05）.There were 11 cases of severe OHSS in the GnRHa group and 1 case in the GnRHA group （x2=4.340,P=0.037）.Conclusions：The pregnancy rates of once ET （including fresh and thawed transplants） in two protocols were not significantly different,however the rate of middle and severe OHSS in the GnRHA group was lower.The GnRHA protocol,without adjustment and with the reduced economic pressures and complications,and with the same pregnancy rate of GnRHa long protocol,may be tried in those infertile patients with PCOS underwent the IVF-ET treatment using freeze-thawed embryos.