降调节人工周期对基础黄体生成素升高的多囊卵巢综合征患者冻胚移植周期临床结局的影响

Effect of Pituitary Down Regulation with Hormone Replacement on Clinical Outcomes of Frozen Embryo Transfer Cycles in PCOS Patients with Elevated Basal LH Level

目的探讨不同内膜准备方案对合并基础黄体生成素(LH)升高的多囊卵巢综合征(PCOS)患者冻胚移植临床结局的影响。方法回顾性分析2016年1月至2019年12月于徐州市中心医院生殖中心行冻胚移植且存在基础LH升高的137例PCOS患者,根据降低基础LH的方法将内膜准备方案分为长效促性腺激素释放激素激动剂(GnRH-a)降调节后激素替代组(GnRH-a组,52例)、达英-35处理后激素替代组(OC组,85例)。比较两组患者的基础情况及转化内膜日子宫内膜厚度、临床妊娠率、早期流产率、异位妊娠率的差异。结果两组患者的年龄、不孕年限、基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、雌二醇(bE2),抗缪勒管激素(AMH)、体质量指数(BMI)比较,差异均无统计学意义(P>0.05)。两组患者移植胚胎数、移植优质胚胎率、囊胚移植率比较,差异均无统计学意义(P>0.05)。GnRH-a降调节后的LH值较OC处理后明显降低(P<0.05)。GnRH-a组转化日子宫内膜厚度高于OC组(P<0.05)。GnRH-a组临床妊娠率高于OC组(P<0.05)。两组早期流产率、异位妊娠率比较,差异无统计学意义(P>0.05)。结论GnRH-a降调节较OC处理可显著降低PCOS患者的LH水平,增加PCOS患者的临床妊娠率。

Objective To investigate the effect of various endometrial preparation protocols on the clinical outcomes of frozen embryo transfer(FET)in polycystic ovary syndrome(PCOS)patients with elevated basal luteinizing hormone(LH)level.Methods Retrospective analysis of 137 PCOS patients who underwent frozen embryo transfer at the Reproductive Medicine Center of Xuzhou Central Hospital from January 2016 to December 2019.The endometrial preparation scheme was divided into two groups:pituitary down-regulation combined with hormone replacement group(GnRH group,52 cases)and Diane-35 treatment combined with hormone replacement group(OC group,85 cases).The basic characteristics,endometrial thickness,clinical pregnancy rate,early abortion rate and ectopic pregnancy rate were compared between the two groups.Results There were no significant differences in age,infertility years,basic follicle stimulating hormone,basic luteinizing hormone,estradiol,AMH,BMI,the number of transferred embryos,high-quality embryo rate and blastocyst transfer rate between the two groups(P>0.05).The LH level was significantly decreased in GnRH group than that in the OC group(P<0.05).The endometrial thickness and clinical pregnancy rate in the GnRH group was higher than that in the OC group(P<0.05).There was no significant difference in early abortion rate and ectopic pregnancy rate between the two groups(P>0.05).Conclusion GnRH-a down regulation can significantly reduce LH level and increase the clinical pregnancy rate of PCOS patients with elevated basal LH level.