多囊卵巢综合征体外受精-胚胎移植中卵巢低反应的高危因素分析

Analysis of high risk factors for poor ovarian response in vitro fertilization in polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)不孕患者实施体外受精-胚胎移植(IVF-ET)时,卵巢低反应(POR)的高危因素。方法回顾性分析2016-2017年北京大学人民医院生殖医学中心行IVF-ET的334例PCOS患者的临床资料,采用GnRH-a长方案、改良长方案及拮抗剂方案三种超排卵方法,分析其获卵数与妊娠率、活产率的关系及主要影响因素。结果三种促排卵方案患者的妊娠率(分别为51.5%、57.1%和37.5%)及活产率(分别为45.5%、42.9%和32.1%)比较,差异均无统计学意义(P>0.05)。获卵数<4枚临床妊娠率(36.4%)与获卵数>4枚的患者妊娠率(57.6%)比较,差异无统计学意义(P>0.05),前者活产率(9.1%)较后者(41.3%)显著降低,差异有统计学意义(P=0.037)。多因素分析结果显示,体质指数(BMI)是PCOS患者获卵数<4枚的主要危险因素。结论高BMI是导致PCOS卵巢低反应的主要危险因素,应重视对高体质量PCOS超排卵患者的管理。

Objective To investigate the possible risk factors for poor ovarian response(POR)of women with polycystic ovary syndrome(PCOS)in vitro fertilization and embryo transfer(IVF-ET).Methods 334 patients with PCOS who underwent assisted reproductive technology(ART)in Peking University People’s Hospital Reproductive Center from 2016 to 2017 were enrolled into this retrospective study.Patients were conducted using the GnRHa long protocol,modified long protocol,and antagonist protocol.The relationship between the pregnant rate,live birth rate and the oocytes number was analyzed.And the risk factors for the POR of patients with PCOS was also analyzed.Results There was no significant difference in pregnancy rate(51.5%,57.1%and 37.5%)and live birth rate(45.5%,42.9%and 32.1%,respectively)in patients with three stimulation protocols(P>0.05).In patients with fewer than 4 oocytes,the pregnancy rate was not different from patients with more than 4 oocytes(36.4%and 57.6%,respectively,P>0.05),but the live birth rate was significantly reduced(9.1%and 41.3%,P=0.037).Multivariate analysis showed that body mass index(BMI)is the main risk factor for PCOS patients with fewer than 4 oocytes.Conclusions High BMI is the main risk factor for POR patients with PCOS,attention should be paid to the management of patients with high BMI patients during superovulation.