早卵泡期长方案治疗中促性腺激素时长对多囊卵巢综合征患者体外受精-胚胎移植助孕治疗结局的影响

Impact of the duration of gonadotropin stimulation in women with polycystic ovary syndrom that using long-acting gonadotropin-releasing hormone agonist long protocol in follicular phase

目的回顾性分析多囊卵巢综合征(PCOS)患者在体外受精-胚胎移植(IVF-ET)助孕治疗过程中不同促性腺激素(Gn)时长患者的临床妊娠结局及导致患者Gn时间延长的相关因素。方法收集2014年1月—2017年5月期间在本院生殖中心采用早卵泡期长方案行IVF-ET助孕治疗的PCOS患者临床资料,根据Gn使用时间按四分位法分为3组(A组:<25%,Gn使用时间<11 d,共182个周期;B组:25%~75%,Gn使用时间11~15 d,542个周期;C组:>75%,Gn使用时间>15 d,216个周期),比较各组间患者基础情况及治疗情况的相关指标。结果 3组患者平均年龄、体质量指数(BMI)、基础卵泡刺激素(FSH)、启动日的黄体生成素(LH)水平、Gn总量、基础睾酮(T)水平及启动日FSH水平组间比较差异有统计学意义(P<0.05);3组患者间的不孕年限、基础LH水平及基础雌二醇(E 2)水平、降调节时间、Gn启动剂量、启动日E 2水平差异均无统计学意义;3组患者间的获卵数、可利用胚胎数、周期取消率、新鲜胚胎移植率、临床妊娠率、胚胎种植率、早期流产率及中重度卵巢过度刺激综合征(OHSS)发生率比较差异均无统计学意义,但中重度OHSS发生率A组较B组及C组有增高趋势。多因素logistic回归分析显示基础FSH、基础T及BMI高水平为Gn使用时间延长的危险因素,而启动日FSH及LH的水平恢复为Gn使用时间延长的保护因素。结论 PCOS患者行早卵泡期长方案治疗Gn使用时间的长短并不影响患者的临床治疗结局,不建议因此而取消周期;降调节后Gn启动日的LH水平低及基础BMI过高可能是导致Gn使用时间延长的主要因素。

Objective To retrospectively analyze the clinical outcomes of patients with different duration of gonadotropin （Gn） stimulation during in vitro fertilization/intracytoplasmic sperm injection-embry transfer （IVF/ICSI-ET） and the related factors that prolong the duration of gonadotropin stimulation in patients with polycystic ovary syndrome （PCOS）.Methods Clinical data of PCOS patients treated by long-acting gonadotropin-releasing hormone agonist （GnRH-a） long protocol in follicular phase were collected from January 2014 to May 2017. According to the duration of Gn stimulation with the quartile method, patients were divided into three groups （group A： 〈25%, the duration of Gn used 〈11 d, 182 cycles; group B： 25%-75%, the duration of Gn used 11-15 d, 542 cycles; group C： 〉75%, the duration of Gn used 〉 15 d, 216 cycles）, and the basic situation of patients and treatment-related indicators were compared among the groups.Results The average age, body mass index （BMI）, basal follicle stimulating hormone （FSH）, the level of luteinizing hormone （LH） on the start-up day, dosage of Gn used, basal testosterone （T） and the level of FSH on the start-up day were significant differences among the three groups （P〈0.05）. The duration of infertility, basal LH and basal estradiol （E2）, the duration of down-regulation, the dosage of Gn used and the level of E2 on start-up day were not significantly different among the three groups. There was no significant difference among the three groups in the number of oocytes retrieved, the number of available embryos, cycle cancellation rate, fresh embryo transfer rate, clinical pregnancy rate, embryo implantation rate, early miscarriage rate and moderate-to-severe ovarian hyperstimulation syndrome （OHSS） incidence. The incidence of moderate and severe OHSS in group A had an increased trend compared with group B and group C. Multi-factor logistic regression analysis showed that basal FSH, basal T and BMI were the risk factors of Gn prolongation, while the start-up day FSH and start-up day LH recover were protective factors of Gn prolongation.Conclusion Prolong the duration of Gn stimulation does not affect the clinical outcome of patients with PCOS using long-acting GnRH-a long protocal in follicular phase, suggesting not canceling cycles. Weight loss before the start of treatment and supplement exogenous LH are important to avoid the duration of Gn stimulation is too long.