GnRH-a扳机对PCOS患者IVF/ICSI-ET治疗结局的影响

Effect of GnRH -a trigger on clinical outcomes of IVF/ICSI -ET in patients with Polycystic ovary syndrome

目的探讨行IVF/ICSI-ET助孕治疗的PCOS患者在使用拮抗剂方案治疗中给予GnRH-a扳机对临床结局的影响。方法回顾性分析2015年1月至2019年8月行拮抗剂方案治疗的PCOS患者469例临床资料,其中HCG扳机者292例,GnRH-a扳机者177例。比较两组患者的基本资料及临床治疗结局。结果两组患者的年龄、BMI、AMH及基础性激素水平比较,均无统计学差异(P>0.05)。两组患者的Gn时间、Gn量、HCG日E2水平、HCG日孕酮水平、获卵数、MII卵率、2PN受精率、可利用胚胎数、移植胚胎数、无胚取消率、临床妊娠率、胚胎种植率及早期流产率均无显著性差异(P>0.05)。但HCG扳机组的全胚冷冻率显著高于GnRH-a扳机组(41.55%VS 29.24%,P=0.008)。两组间患者的OHSS发生率无显著性差异(P>0.05),但GnRH-a扳机组进行全胚冷冻的患者均无OHSS发生。结论使用拮抗剂方案治疗的PCOS患者GnRH-a扳机能够有效的预防早发性OHSS的发生,在传统孕激素的基础上加用雌激素进行黄体支持能够获得与HCG扳机类似的妊娠结局,减少因预防OHSS进行的全胚冷冻率。

Objective To investigate the effect of GnRH-a trigger on clinical outcomes in patients with PCOS undergoing IVF/ICSI-et with antagonist regimen.Methods Retrospective analysis was performed on 469 PCOS patients treated with antagonist regimen from January 2015 to August 2019,292 patients were HCG trigger and 177 patients were GnRH-a trigger.The basic datas and clinical outcomes of the two groups were compared.Results There were no statistically significant differences in age,BMI,AMH and Basal sex hormone levels between the two groups(P>0.05).There was no significant difference in The days of Gn,The dose of Gn,The level of E2 and progesterone on HCG day,Number of eggs harvested,MII egg rate,2PN fertilization rate,Number of available embryos,Number of embryos transferred,no embryo cancellation rate,clinical pregnancy rate,embryo implantation rate and early abortion rate between the two groups(P>0.05).However,The freezing all rate of HCG trigger group was significantly higher than that of GnRH-a trigger(41.55%VS 29.24%,P=0.008).There was no significant difference in the incidence of OHSS between the two groups(P>0.05),but there was no OHSS in patients undergoing freezing all patients with GnRH-a trigger.Conclusion GnRH-a trigger can effectively prevent the occurrence of early OHSS in PCOS patients treated with antagonist regimens.Add estrogen On the traditional lute support of progesterone can achieve a similar pregnancy outcome to that with HCG trigger,and can reduce the freezing all rate due to the prevention of OHSS.