取卵后当日添加来曲唑和GnRH-ant预防卵巢过度刺激综合征的疗效观察

Effect of GnRH antagonist and letrozole for prevention of ovarian hyperstimulation syndrome

目的探讨联合使用来曲唑和促性腺激素释放激素拮抗剂(GnRH-ant)对于防治早发型卵巢过度刺激综合征(OHSS)的效果。方法回顾性分析2018年3月至2019年2月于本院生殖中心接受助孕治疗、因OHSS高风险取消新鲜周期胚胎移植而行全胚冷冻的61例患者的临床资料。根据取卵日是否添加GnRH-ant和来曲唑分为研究组(39例)和对照组(22例)。对照组采用常规防治方法;研究组在常规防治的基础上,加用GnRH-ant和来曲唑。比较两组患者的一般资料、相关实验室指标及OHSS发生情况。结果两组患者的一般资料比较均无显著性差异(P>0.05)。两组患者的扳机日FSH、LH及P水平、≥14 mm卵泡数、获卵数、MⅡ卵数、2PN数、可移植胚胎数、优质胚胎数等比较亦均无显著性差异(P>0.05),研究组扳机日E 2水平显著高于对照组(P<0.05)。两组患者取卵后第3天双侧卵巢平均直径比较无显著性差异(P>0.05),研究组取卵后第3天的E 2水平显著低于对照组(P<0.05),E 2水平下降幅度显著高于对照组(P<0.05)。研究组中度OHSS发生率(7.7%)略低于对照组(13.6%),但无显著性差异(P>0.05)。结论OHSS高危患者在取卵术后当日联合使用来曲唑和GnRH-ant,可明显降低黄体期E 2的水平,且中度OHSS的发生率有降低的趋势。

Objective:To explore the efficiency of using letrozole and GnRH antagonist(GnRH-ant)in prevention of the ovarian hyperstimulation syndrome(OHSS).Methods:The data of 61 OHSS high risk patients who underwent whole embryo freezing treatment due to the high risk of OHSS to cancel fresh-cycle embryo transfer at our reproductive center from March 2018 to February 2019 were retrospectively analyzed.The patients were divided into control group(n=22)and the study group(n=39)according to whether application of letrozole and GnRH-ant on the oocyte retrieval day.The patients in the control group were given conventional preventive treatment.The study group was added GnRH-ant and letrozole other than above preventative treatment.The general data,related laboratory indicators,and the incidence of OHSS were compared between the two groups.Results:There was no significant difference in general information between the two groups of patients(P>0.05).There were also no significant differences in FSH,LH,and progesterone levels on the trigger day,number of follicle≥14 mm,number of oocyte retrieval,MⅡoocyte number,2PN embryos number,transplantable embryos,and high-quality embryos between the two groups(P>0.05).The E 2 level on the trigger day in the study group was significantly higher than that in the control group(P<0.05).There was no significant difference in the mean diameter of bilateral ovaries on the 3 rd day after oocyte retrieval between the two groups(P>0.05).The E 2 level on the 3 rd day after oocyte retrieval in the study group was significantly lower than that in the control group(P<0.05),and the decrease of E 2 level was significantly higher than that of the control group(P<0.05).The incidence of moderate OHSS(7.7%)in the study group was slightly lower than that in the control group(13.6%),but there was no significant difference(P>0.05).Conclusions:Administrating letrozole combined with GnRH-ant on the oocytes retrieval day can reduce E 2 level at luteal phase,and the incidence of moderate OHSS tends to decrease.