多囊卵巢综合征患者应用卵泡期长效长方案的体外受精结局

Efficacy of follicular phase long-acting gonadotropin-releasing hormone agonist down-regulated long protocol for infertility treatment in polycystic ovary syndrome patients

目的探讨不同方案对多囊卵巢综合征(PCOS)患者进行体外受精/单精子卵胞质内显微注射(IVF/ICSI)结局的影响.方法回顾性分析2015年1月至2016年12月在郑州大学第一附属医院生殖中心进行第一周期IVF/ICSI助孕的PCOS患者的临床资料.采用卵泡期长效降调节方案的851例患者作为研究组;采用黄体期短效降调节方案的632例患者作为对照组,比较两组的妊娠结局情况.结果患者在平均年龄、不同体质量指数(BMI)分布、因卵巢过度刺激综合征(OHSS)倾向取消周期以及移植胚胎数组间差异均无统计学意义(P>0.05).研究组较对照组促性腺激素(Gn)使用剂量多、Gn使用时间长、人绒毛膜促性腺激素(hCG)注射日内膜厚度厚和获卵数少、可移植胚胎数少,差异均有统计学意义(均P<0.0001).研究组在取卵周期的临床妊娠率(76.17%)和活产率[34.43%(95%CI=31.24%~37.62%)]高于对照组[59.26%,P<0.0001;24.68%(95%CI=21.32%~28.05%),P<0.0001].所有冻融胚胎移植后2种方案的累积活产率差异无统计学意义[69.21%(95%CI=66.11%~72.31%)比67.88%(95%CI=64.24%~71.52%),P=0.5843].BMI≥25.00 kg/m^2患者的累积活产率研究组略高于对照组,差异无统计学意义(P=0.1265).结论与黄体期短效长方案相比,不同BMI的PCOS患者应用卵泡期长效长方案活产率均显著升高,累积活产率无明显差异.

Objective To evaluate the effect of different methods on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in patients with polycystic ovary syndrome (PCOS). Methods This retrospective study examined the outcomes of IVF/ICSI with different down-regulated long protocols in PCOS. All first IVF/ICSI treatment cycles between January 2015 and December 2016 in Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University were analyzed. Patients were recruited, who were treated with follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) down-regulated long protocol as study group (n=851) and luteal phase short-acting Triptorelin down-regulated long protocol as control group (n=632). The pregnancy outcomes were analyzed. Results The basal line in age, body mass index (BMI), cycle cancellation rate of ovarian hyperstimulation syndrome (OHSS), average number of transplanted embryos were comparable in the two groups. Total dosage and duration of gonadotropin (Gn) used, endometrial thickness and estradiol level on the human chorionic gonadotropin (hCG) trigger day in study group were higher than those in control group, while the number of the oocyte retrieval and transplantable embryos was lower than that in control group, the differences were statistically significant (P<0.01). In study group, the clinical pregnancy rate (76.17%) and the live birth rate [34.43%(95% CI=31.24%-37.62%)] were higher than those in control group [59.26%, P<0.01;24.68%(95% CI=21.32%-28.05%), P<0.01]. But the total cumulative live birth rate was comparable in the two groups [69.21%(95% CI=66.11%-72.31%) vs. 67.88%(95% CI=64.24%-71.52%), P=0.584 3]. When the results were stratified in BMI, the cumulative live birth rate got better outcome in BMI≥25.00 kg/m^2 subgroup without statistically significant (P=0.126 5). Conclusion PCOS patients can get better live birth rate and similiar cumulative live birth rate after follicular phase long-acting GnRH-a down-regulated long protocol.