种植前苍附导痰汤及奥利司他预处理对肥胖型多囊卵巢综合征行体外受精-胚胎移植术患者临床结局的影响

Effect of Pretreatment with Cangfu Daotan Decoction and Orlistat Before Transfer on the Clinical Outcome of Patients with Obese Polycystic Ovary Syndrome Undergoing In Vitro Fertilization-Embryo Transfer

目的观察种植前联合应用苍附导痰汤及奥利司他胶囊对肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)患者临床结局的影响。方法将60例行拮抗剂方案IVF助孕的肥胖型PCOS患者按照随机数字表法分为观察组和对照组,每组30例。观察组在使用拮抗剂方案前联合使用3个月的苍附导痰汤及奥利司他胶囊;对照组使用拮抗剂方案前3个月单纯使用奥利司他胶囊。观察两组患者用药前后体质量指数(body mass index,BMI)和血脂[胆固醇(cholesterol total,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)]水平;比较两组患者的促性腺激素(gonadotropin,GN)用量和时间、获卵数、双原核受精率、优质胚胎率,冻胚移植(frozen embryo transplantation,FET)周期累计临床妊娠率、早期流产率。结果与治疗前比较,两组患者治疗后BMI、TG、TC、LDL-C均显著下降,HDL-C显著上升,差异均有统计学意义(P<0.05);观察组BMI、TG、TC下降程度均显著高于对照组(P<0.05)。与对照组比较,观察组GN用量及GN时间下降,双原核受精率、优胚率、临床妊娠率上升,差异均有统计学意义(P<0.05);早期流产率呈下降趋势(P>0.05)。结论苍附导痰汤可有效降低肥胖型PCOS患者的BMI和血脂水平,提高卵子的受精能力,改善胚胎质量,降低GN使用时间及总量,提高冻胚移植临床妊娠率,有效改善IVF助孕的肥胖型PCOS患者临床结局。

Objective To investigate the effect of pretreatment with Cangfu Daotan Decoction and orlistat before transfer on the clinical outcome of patients with obese polycystic ovary syndrome(PCOS)undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods A total of 60 patients with obese PCOS who underwent IVF with the antagonist regimen to promote pregnancy were divided into observation group and control group using a random number table,with 30 patients in each group.Before the use of the antagonist regimen,the patients in the observation group were given Cangfu Daotan Decoction and orlistat for 3 months,and those in the control group were given orlistat alone for 3 months.The two groups were observed in terms of body mass index(BMI)and blood lipids[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)]before and after treatment;the two groups were compared in terms of the amount and duration of gonadotropin(GN)use,number of retrieved oocytes,2PN fertilization rate,rate of high-quality embryos,cumulative clinical pregnancy rate during frozen embryo transfer(FET)cycle,and rate of early miscarriage.Results After treatment,both groups had significant reductions in BMI,TG,TC,and LDL-C and a significant increase in HDL-C(P<0.05),and compared with the control group,the observation group had significantly greater reductions in BMI,TG,and TC(P<0.05).Compared with the control group,the observation group had significant reductions in the amount and duration of GN use and significant increases in 2PN fertilization rate,rate of high-quality embryos,and clinical pregnancy rate(P<0.05),as well as a tendency of reduction in early miscarriage(P>0.05).Conclusion In patients with obese PCOS,Cangfu Daotan Decoction can effectively reduce BMI and blood lipids,improve the fertilization ability of oocytes and embryo quality,reduce the amount and duration of GN use,increase the clinical pregnancy rate of FET,and effectively improve the clinical outcome of patients with obese PCOS undergoing IVF to promote pregnancy.