摘要
目的研究促性腺激素释放激素激动剂(GnRH-a)扳机对多囊卵巢综合征(PCOS)患者新鲜周期移植临床妊娠率的影响。方法回顾性分析2016年1月1日至2018年6月30日就诊本院生殖中心行IVF/ICSI的442例PCOS患者的临床资料,根据扳机日使用的扳机方案分为两组:GnRH-a扳机组(163例),在扳机日使用GnRH-a0.2mg扳机;HCG扳机组(279例),在扳机日使用HCG10000U扳机。卵巢过度刺激综合征(OHSS)低风险者(GnRH-a扳机组68例,HCG扳机组79例)取卵后5d移植1枚囊胚。GnRH-a扳机组黄体支持从取卵当天开始使用戊酸雌二醇(4mg/d)、地屈孕酮(40mg/d)和黄体酮阴道缓释凝胶(90mg/d),至孕10周停药。HCG扳机组黄体支持不使用戊酸雌二醇,其余同GnRH-a扳机组。观察获卵数、可利用胚胎数、MⅡ卵率、鲜胚移植周期临床妊娠率、持续妊娠率、早期流产率及OHSS发生率。结果两组之间的获卵数[(23.03±7.95)vs.(21.92±8.43)]、MⅡ卵率(89.60%vs.88.90%)、可利用胚胎数[(8.93±5.61)vs.(8.80±4.95)]、临床妊娠率(55.88%vs.65.82%)、持续妊娠率(48.52%vs.56.96%)及早期流产率(13.16%vs.18.42%)差异均无统计学意义(P>0.05)。HCG扳机组的OHSS发生率高于GnRH-a扳机组(8.24%vs.1.23%),差异有统计学意义(P<0.05)。结论本研究中GnRH-a扳机未降低PCOS患者新鲜周期移植的临床妊娠率,但显著降低OHSS的发生率。
Objective: To investigate the effect of GnRH agonist(GnRH-a)trigger in clinical pregnancy rate of fresh embryo transfer cycles in the patients with polycystic ovary syndrome(PCOS).Methods:The data of 442 PCOS patients undergone IVF/ICSI in the reproductive center of our hospital from January 1,2016 to June 30,2018 were retrospectively analyzed.The patients were divided into two groups according to the trigger protocol.The patients in GnRH-a trigger group(n=163)took GnRH-a0.2 mg,and the HCG trigger group(n=279)took HCG 10 000 Uon the trigger day.One blastocyst was transplanted 5 days after oocyte retrieval for the patients with low risk of OHSS[GnRH-a trigger group(n=68),HCG trigger group(n=79)].Luteal phase support of the patients in GnRH-a trigger group was started from the day of oocyte retrieval to 10 weeks gestation with estradiol valerate(4 mg/day),dydrogesterone(40 mg/day)and progesterone sustained-release vaginal gel(90 mg/day).Luteal phase support in HCG trigger group was same as GnRH-a trigger group except estradiol valerate was not used.The indication of primary outcome was clinical pregnancy rate.Secondary outcomes included total number oocytes retrieved,MⅡoocyte rate,number of available embryos,ongoing pregnancy rate,early abortion rate and the incidence of ovarian hyperstimulation syndrome(OHSS).Results:There were no significant differences in clinical pregnancy rate,total number oocytes retrieved,MⅡ oocyte rate,number of available embryos,ongoing pregnancy rate and early abortion rate between two groups(P>0.05).The incidence of OHSS in HCG trigger group was significantly higher than that in the GnRH-a trigger group(P<0.05).Conclusions:GnRH-a trigger does not reduce the clinical pregnancy rate in fresh embryo transfer cycles,but significantly reduces the incidence of OHSS in the patients with polycystic ovary syndrome.
作者
胡秀玉
彭月婷
莫美兰
张宏展
徐士儒
胡晓东
HU Xiu-yu;PENG Yue-ting;MO Mei-lan;ZHANG Hong-zhan;XU Shi-ru;HU Xiao-dong(Shenzhen Zhongshan Urology Hospital,Shenzhen 518000)
出处
《生殖医学杂志》
CAS
2019年第8期890-895,共6页
Journal of Reproductive Medicine
基金
深圳市医疗卫生三名工程项目(SZSM201502035)