改良超长方案对IVF-ET治疗PCOS伴不孕患者受精率及妊娠结局的影响

Effects of modified ultra-long protocol on fertilization rate and pregnancy outcome of PCOS patients with infertility treated by IVF-ET

目的观察改良超长方案对行体外受精-胚胎移植(IVF-ET)治疗的多囊卵巢综合征(PCOS)伴不孕患者受精率与妊娠结局的影响。方法回顾性分析2018年1月至2020年1月平顶山市计划生育科学技术研究所收治的80例PCOS伴不孕患者的临床资料,将其中经改良超长方案治疗的42例患者纳入改良组,经拮抗剂方案治疗的38例患者纳入拮抗组,方案治疗结束时,记录并对比两组促性腺激素用药相关情况、注射人绒毛促性腺激素(HCG)当天相关指标[子宫内膜厚度、促黄体生成素(LH)、卵泡刺激素(FSH)、黄体酮、雌二醇]、受精情况(平均取卵数目、成熟卵数、成功受精卵数)及妊娠结局(临床妊娠、流产率、持续妊娠率)。结果与拮抗组相比,改良组促性腺激素用药时间较长,成熟卵数量、成功受精卵数量较多,差异有统计学意义(P<0.05);改良组子宫内膜厚度、雌二醇水平、临床妊娠率、持续妊娠率均高于拮抗组,LH水平、用药总量均低于拮抗组,差异有统计学意义(P<0.05);两组黄体酮水平、取卵数、异位妊娠率、流产率比较差异未见统计学意义(P>0.05)。结论PCOS伴不孕患者接受IVF-ET治疗,改良超长方案较拮抗剂方案可显著提高受精成功率,利于改善患者的临床妊娠结局,是一种优选的促排方案。

Objective To observe the effects of the modified ultra-long protocol on fertilization rate and pregnancy outcomes of patients with polycystic ovary syndrome(PCOS)complicated by infertility treated by in vitro fertilization-embryo transfer(IVF-ET).Methods The clinical data of 80 patients with PCOS complicated by infertility admitted to Pingdingshan Family Planning Science and Technology Research Institute from January 2018 to January 2020 were retrospectively analyzed.Among them,42 patients treated by the modified ultra-long protocol were included in the modified group,and 38 patients who were treated by the antagonistic protocol were included in the antagonist group.Usage of gonadotropins,relevant indicators on the day of injection of human villous gonadotropin(HCG),such as endometrial thickness,luteinizing hormone(LH),follicle stimulating hormone(FSH),progesterone and estradiol,fertilization(average number of eggs taken,number of mature eggs,number of successfully fertilized eggs),pregnancy outcomes(clinical pregnancy,miscarriage rate,continuous pregnancy rate)were recorded and compared between the two groups.Results Compared with the antagonist group,the modified group took gonadotropins for longer time,moreover,the numbers of mature eggs and successfully fertilized eggs were larger in the modified group(P<0.05).The endometrial thickness,estradiol level,clinical pregnancy rate and continuous pregnancy rate of the modified group were higher than those of the antagonist group,however,the LH level and the total usage of medication of the modified group were lower than those of the antagonist group,and the difference was statistically significant(P<0.05).There was no significant difference in progesterone level,egg retrieval number,ectopic pregnancy rate and miscarriage rate between the two groups(P>0.05).Conclusions Receiving IVF-ET treatment and adopting a modified ultra-long protocol of megication can significantly improve the success rate of fertilization for PCOS patients with infertility,compared with antagonist protocol.And the treatment method can help to improve the clinical pregnancy outcome of patients,which is an optimized way to promote elimination.