拮抗剂与高孕激素下促排卵方案用于多囊卵巢综合征患者IVF治疗效果比较

Comparison of IVF efficacy between GnRH antagonist protocol and progestin-primed ovarian stimulation protocol in PCOS patients

目的比较拮抗剂方案与高孕激素状态下促排卵(PPOS)方案在多囊卵巢综合征(PCOS)患者行IVF助孕治疗中的应用效果。方法回顾性分析2016年11月至2017年11月在本院行IVF助孕治疗的138例单纯PCOS不孕症患者的临床资料,根据促排卵方案的不同将患者分为两组:PPOS组(57例)和拮抗剂组(81例)。比较两组患者的一般资料、促排卵情况及胚胎实验室指标。结果两组患者的年龄、月经周期、不孕年限、体重指数(BMI)、基础窦卵泡数、基础FSH、基础LH及基础E2等比较均无显著性差异(P>0.05)。拮抗剂组的Gn总量显著低于PPOS组[(1 725.5±612.9)vs.(2 147.3±811.5)U],早发LH峰发生率(7.4%vs.0%)、直径≥14mm卵泡数[(15.2±8.2)vs.(12.7±7.2)个]、E2峰值[(16 573.7±8 844.7)vs.(12 980.8±7 486.8)pmol/L]、HCG日孕酮(P)水平[(3.15±1.53)vs.(2.68±1.53)nmol/L]、获卵数[(17.2±9.7)vs.(13.0±8.3)个]、轻中度OHSS发生率(6.2%vs.0%)均显著高于PPOS组(P<0.05)。两组间的Gn用药天数、2PN受精率、卵裂率、优质胚胎数、重度OHSS发生率比较均无显著性差异(P>0.05)。结论 PPOS方案能获得与拮抗剂方案相似的优质胚胎数,且能更好地抑制早发LH峰,减少轻中度OHSS发生率,可作为PCOS患者促排卵方案的选择之一。

Objective ： To compare the IVF efficacy between GnRH antagonist （GnRH-ant） protocol and progestin-primed ovarian stimulation （PPOS） protocol in patients with polycystic ovary syndrome （PCOS）.Methods ： A retrospective study was performed including 138 PCOS patients undergone IVF treatment in our center from November 2016 to November 2017.Among them,81 cycles were in GnRH-ant protocol group and 57 cycles in PPOS protocol group.The clinical characteristic of patients and the efficacy of the controlled ovarian hyperstimulation （COH） were compared between the two groups.Results ： There were no significant differences in age,menstrual cycle,infertility years,body mass index （BMI）,number of basal antral follicles,basal levels of FSH,LH and E 2 between the two groups （ P 〉0.05）.The total amount of gonadotropin （Gn） used [（1 725.5±612.9） vs.（2 147.3±811.5） U],the occurrence of premature LH surge（7.4% vs.0%）,the number of follicles with diameter ≥14 mm [（15.2±8.2）vs.（12.7±7.2）],the E 2 peak level [（16 573.7±8 844.7）vs.（12 980.8±7 486.8） pmol/L],the progesterone level on the HCG day [（3.15±1.53）vs.（2.68±1.53） nmol/L],the number of oocyte retrieved [（17.2±9.7）vs.（13.0±8.3）] and the incidence of mild-to-moderate OHSS（6.2% vs.0% ）in GnRH-ant protocol group were significantly higher than those in PPOS protocol group （ P 〈0.05）.There was no significant difference in stimulation days,2PN fertilization rate,cleavage rate,number of good quality embryo,and the incidence of severe OHSS between the two groups.Conclusions ： PPOS protocol can obtain similar number of good quality embryos compared with GnRH-ant protocol,and effectively inhibit the premature LH surge and the incidence of mild-to-moderate OHSS.Therefore,PPOS can be used as one of the choices for ovulation induction in patients with PCOS.