不同促排卵方案在多囊卵巢综合征病人行体外受精-胚胎移植/卵胞质内单精子注射中的应用探讨

Application of different controlled ovarian stimulation protocols in in vitro fertilization-embryo transfer/intracytopasmic sperm injection for patients with polycystic ovary syndrome

目的探讨卵泡期长方案、改良超长方案以及拮抗剂方案3种不同超促排卵方案在行体外受精-胚胎移植/卵胞质内单精子注射(IVF-ET/ICSI)助孕的多囊卵巢综合征(PCOS)病人中应用价值。方法回顾性分析在郴州市第一人民医院生殖中心2017年7月至2019年5月间行IVF-ET/ICSI治疗的PCOS病人527个周期的临床资料,根据促排卵方案的不同分为三组,卵泡期长方案组(A组),改良超长方案组(B组),拮抗剂方案组(C组)。比较三组病人的一般资料、促排卵情况及种植率、临床妊娠率、中重度卵巢过度刺激综合征(OHSS)发生率、抱婴率等临床结局差异。结果(1)三组病人一般情况、基础性激素水平和促排卵药物、促性腺激素(Gn)天数、Gn量、绒毛膜促性腺激素(HCG)日雌二醇值、获卵数、2PN受精率、卵裂率、优胚率、移植胚胎数、OHSS发生率、早期流产率比较差异无统计学意义(P>0.05)。(2)A组及B组启动日黄体生成素(LH)、雌二醇值、HCG日LH值均显著低于C组,A组、B组重组人黄体生成素(r-hLH)用量显著高于C组(P<0.05)。(3)A组、B组HCG日内膜厚度[(11.22±2.51)mm,(11.10±2.73)mm]、临床妊娠率(70.23%,65.83%)、种植率(53.78%,50.00%)、抱婴率(59.54%,55.28%)均显著高于C组[(9.81±2.35)mm,50.94%,38.04%,39.62%],A组OHSS风险取消移植率(18.93%)显著低于C组(36.78%)(P<0.05)。结论卵泡期长方案与改良超长方案的临床妊娠率、抱婴率高于拮抗剂方案,可为PCOS病人行IVF-ET/ICSI助孕提供方案选择。

Objective To compare the clinical outcomes of different controlled ovarian stimulation(COS)protocols for polycystic ovary syndrome(PCOS)patients'in vitro fertilization-embryo transfer/intracytopasmic sperm injection(IVF-ET/ICSI).Methods A retrospective study was conducted on the women with PCOS undergoing IVF-ET/ICSI in Reproductive Medicine Center of Chenzhou NO.1 People's Hospital from July 2017 to May 2019.A total of 527 cycles were included in the study and patients were assigned into three groups according to ovulation promotion protocols:group A for long-term follicular phase gonadotropin-releasing hormone(GnRH)agonist protocol,group B for modified super-long GnRH agonist protocol,group C for GnRH antagonist protocol.A comparison was made of general information,ovulation induction,implantation rate,clinical pregnancy rate,moderate and severe ovarian hyperstimulation syndrome(OHSS)incidence,and birth rate among the three groups.Results There were no significant differences in general information,basic hormone levels and ovulation induction,total amount of gonadotropin(Gn)used,Gn days,E_(2) levels on HCG day,number of oocytes retrieval,2PN fertilization rate,cleavage rate,good quality embryos rate,number of embryos transferred,moderate and severe OHSS incidence and early abortion rate among the three groups(P>0.05).The LH&E2 levels on start-up day,LH levels on HCG day in group A and group B were both slightly lower than those in group C,while the r-hLH dosages in group A and group B were both slightly higher than those in group C(all P<0.05).The endometrial thicknesses on HCG day,clinical pregnancy rates,implantation rates,and birth rates in group A and group B[(11.22±2.51)mm,(11.10±2.73)mm;70.23%,65.83%;53.78%,50.00%;59.54%,55.28%]were all sligntly higher than those in group C[(9.81±2.35)mm,50.94%,38.04%,39.62%;all P<0.05].The OHSS risk cancellation transplant rate in group Awas significantly lower than that in group C(18.93%vs.36.78%;P<0.05).Conclusion Compared with GnRH antagonist protocol,the long-term follicular phase GnRH agonist protocol and modified super-long GnRH agonist protocol can achieve better clinical pregnancy outcome and birth rate,which can provide an alternative choice for the treatment of PCOS.