GnRH长效激动剂方案对PCOS不孕症患者雌孕激素及妊娠结局影响

Effect of GnRH long-acting agonist regimen on the levels of E2 and P and pregnancy outcomes of women with infertility induced by PCOS

目的:分析促性腺激素释放激素(GnRH)长效激动剂方案治疗多囊卵巢综合征(PCOS)不孕症效果及对患者血清雌二醇(E2)、孕酮(P)水平和妊娠结局影响。方法:选取2016年1月—2019年1月本院收治的PCOS不孕症患者360例,依据治疗方案不同分为观察组(n=166)、对照组(n=194),两组均予以克罗米芬或来曲唑促排卵方案,在主导卵泡平均直径18~23 mm时,观察组予以GnRH长效激动剂方案(醋酸曲普瑞林)0.1 mg,对照组予以绒毛膜促性腺激素(HCG)6000~10000 IU诱导卵泡成熟,对比两组排卵质量、性激素水平及妊娠结局。结果:两组诱发排卵日子宫内膜厚度、≥14 mm卵泡数、成熟卵泡数比较无差异(P>0.05),观察组优势卵泡数(3.15±0.34个)高于对照组,诱发排卵日E2水平(346.78±35.41 pg/ml)低于对照组,P/E2(1.75±0.18)高于对照组(均P<0.05),两组P、LH水平无差异(P>0.05);观察组受精率、卵裂率、优质胚胎率、临床妊娠率均高于对照组,卵巢过度刺激综合征、下周期囊肿发生率低于对照组(均P<0.05),两组移植胚胎数、早期流产率、异位妊娠率比较无差异(P>0.05)。结论:GnRH激动剂方案治疗PCOS不孕症,可更有效提高排卵质量,改善性激素水平及妊娠结局。

Objective:To analyze the effect of GnRH long-acting agonist regimen on the levels of serum estradiol(E2)and progesterone(P)and pregnancy outcomes of women with infertility induced by polycystic ovary syndrome(PCOS).Methods:360 women with infertility induced by PCOS were selected and were divided into observation group(n=166)and control group(n=194)according to their treatment regimen from January 2016 to January 2019.All women were treated with clomiphene or letrozole to promote ovulation.When the average diameter of their dominant follicle reached 18-23 mm,the women in the observation group were treated with 0.1 mg of GnRH long-acting agonist(triptorelin acetate)to induce follicle maturation,and the women in the control group were treated with 6000-10000 IU chorionic gonadotropin(HCG)to induce follicle maturation.The ovulation quality,levels of hormones,and pregnancy outcomes of women were compared between the two groups.Results:There were no significant different in endometrial thickness on the day of induced ovulation,the number of follicles≥14 mm,and the number of mature follicles of women between the two groups(P>0.05).The number of dominant follicles of women in the observation group was 3.15±0.34,which was significant more than that of women in the control group.E2 level of women in the observation group on the day of induced ovulation was 346.78±35.41 pg/ml,which was significant lower than that of women in the control group,and the P/E2 value of women in the observation group on the day of induced ovulation was 1.75±0.18,which was significant higher than that of women in the control group(P<0.05).There were no significant different in the levels of P or luteinizing hormone(LH)of women between the two groups(P>0.05).The fertilization rate,cleavage rate,high-quality embryo rate,and clinical pregnancy rate of women in the observation group were significant higher than those of women in the control group,but the incidence rates of ovarian hyperstimulation syndrome(OHSS)and the cysts occurrence in next cycle of women in the observation group were significant lower(P<0.05).There were no significant different in the number of transferred embryos,early abortion rate,and the rate of ectopic pregnancy of women between the two groups(P>0.05).Conclusion:GnRH agonist regimen for treating women with infertility induced by PCOS can effectively improve the quality of ovulation,and improve the levels of hormones and pregnancy outcomes.