多囊卵巢综合征患者应用高孕激素状态下促排卵方案的体外受精结局

Comparison of efficacy between progestin-primed ovarian simulation and gonadotropin-releasing hormone antagonist protocol in polycystic ovary syndrome patients

目的探讨高孕激素状态下促排卵(PPOS)方案在治疗多囊卵巢综合征(PCOS)患者的临床效.果。方法回顾性队列研究分析2016年9月—2018年2月期间在河南省人民医院生殖中心行体外受精/卵胞质内单精子显微注射技术(IVF/ICSI)助孕的159例PCOS患者的临床资料,其中87例采用PPOS方案(PPOS组),72例采用拮抗剂方案(拮抗剂组),观察比较2种方案患者的基本情况、促排卵情况及妊娠结局。结果患者的年龄、体质量指数(BMI)、基础激素水平等基础资料,组间差异均无统计学意义(P>0.05)。PPOS组既往IVF/ICSI失败次数大于拮抗剂组,差异有统计学意义(P=0.006)。促性腺激素(Gn)用量[(2124.86±1164.67)IU]、人绒毛膜促性腺激素(hCG)注射日卵泡刺激素(FSH)[(11.56±3.35)IU/L]、hCG注射日优势卵泡数(直径≥14mm)(8.86±5.29)、hCG注射日雌二醇水平[(2024.50±1227.23)ng/L]在PPOS组均大于拮抗剂方案组[(1470.89±667.92)IU,(9.50±3.41)IU/L,7.11±5.18,(1529.44±1300.84)ng/L],而获卵率(74.69%)低于拮抗剂组(78.87%),差异有统计学意义(P=0.035)。全部胚胎冷冻首次复苏时,周期取消率、生化妊娠率、临床妊娠率、早期流产率、宫外孕率和累积妊娠率组间差异均无统计学意义(P>0.05)。结论PPOS方案在PCOS患者中应用能较好地抑制早发黄体生成素(LH)峰,与拮抗剂方案相比能进一步降低OHSS的发生风险,获得类似的临床妊娠结局。

Objective To compare the efficacy between the progestin primed ovarian stimulation (PPOS) protocol and gonadotropin-releasing hormone antagonist (GnRH-A) protocol in polycystic ovary syndrome (PCOS) patients who underwent in vitro fertilization (IVF). Methods A retrospective analysis was performed in a total of 159 patients with PCOS who performed IVF/intracytoplasmic sperm injection (ICSI) from September 2016 to February 2018 in Reproductive Center of Henan Province People’s Hospital. Among them, 87 patients were treated with PPOS protocol and 72 with GnRH-A protocol. The basic information, process of controlled ovarian hyperstimulation, and pregnancy outcome were compared between the two groups. Results There were no statistically significant differences in age, body mass index (BMI), basal sex hormone levels between the two groups (P>0.05). The number of previous failures in PPOS group was greater than that in GnRH-A group, and the difference was significant (P=0.006). Amount of gonadotropin (Gn)[(2 124.86±1 164.67) IU] and follicle stimulating hormone (FSH)[(11.56±3.35) IU/L], the number of dominant follicle (diameter≥14 mm)(8.86±5.29), estradiol level on the human chorionic gonadotropin (hCG) trigger day [(2 024.50±1 227.23) ng/L] in PPOS group were higher than those in GnRH-A group [(1 470.89±667.92) IU,(9.50±3.41) IU/L, 7.11±5.18,(1 529.44±1 300.84) ng/L], while the oocyte retrieval rate (74.69%) was lower than that in GnRH-A group (78.87%), the differences were statistically significant (P=0.035). Between the two groups, cycle cancellation rate, biochemical pregnancy rate, clinical pregnancy rate, early abortion rate and ectopic pregnancy rate had no significant differences (P>0.05). When first frozen embryo transfer (FET) after freezing all the fresh embryos were carried out. And the cumulative pregnancy rates after egg retrievals between the two groups had no statistical differences. Conclusion The application of PPOS protocol in PCOS patients can effectively inhibit the early LH peak, and can further reduce the risk of OHSS compared with GnRH-A protocol, can achieve similar clinical pregnancy outcomes.