3种不同促排卵方案对PCOS患者子宫内膜容受性及妊娠结局的影响

Effects of three different stimulation protocols for ovulation induction on endometrial receptivity and pregnancy outcome in infertile patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)患者采用改良长方案、拮抗剂方案及黄体期长方案对子宫内膜容受性及妊娠结局的影响。方法选择2018年1月至2019年6月在金华市人民医院生殖中心首次接受体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗的PCOS不孕患者285例,其中改良长方案55例(改良组)、拮抗剂方案91例(拮抗组)、黄体期长方案139例(黄体组),比较3组患者基本资料,不同方案促排卵后的卵巢刺激情况、胚胎及妊娠结局相关指标。结果改良组患者促性腺激素(Gn)用量、Gn使用天数均多于拮抗组,扳机日促黄体生成素水平低于拮抗组,子宫内膜厚度大于拮抗组,差异均有统计学意义(均P<0.05);改良组患者Gn用量多于黄体组(P<0.05);拮抗组患者Gn用量、Gn使用天数均少于黄体组,中重度卵巢过度刺激综合征(OHSS)发生率低于黄体组,差异均有统计学意义(均P<0.05)。3组患者正常受精率、有效胚胎数、有效胚胎率、优胚数、优胚率、全胚冷冻率、新鲜移植周期数、移植胚胎数、种植率、临床妊娠率、多胎妊娠率、流产率、异位妊娠率比较差异均无统计学意义(均P>0.05)。结论改良长方案有助于改善PCOS患者的子宫内膜容受性,不增加OHSS发生的风险,可用于PCOS患者的治疗,但是否有助于提高卵子质量,改善妊娠结局,仍需进一步研究。

Objective To compare the effect of modified long protocol,antagonist protocol and luteal long protocol for ovulation induction on endometrial receptivity and pregnancy outcome in infertile patients with polycystic ovary syndrome(PCOS).Methods A total 285 infertile PCOS patients who received the first in vitro fertilization-embryo transfer(IVF-ET)/intracytoplasmic sperm injection(CSI)treatment in the Center of Reproductive Medicine of Jinhua People's Hospital from January 2018 to June 2019 were enrolled in the study.Three different stimulation methods were applied for ovulation induction:55 cases received the modified long protocol,91 cases received antagonist protocol and 139 cases received luteal long protocol.The general information,ovulation induction status,embryo and pregnancy outcomes were compared among the three groups.Results The modified long protocol had higher total gonadotropin(Gn)doses,Gn days and endometrial thickness than antagonist protocol(all P<0.05).The LH level in the modified long protocol was lower than that in the antagonist protocol on trigger day(P<0.05).The modified long protocol had higher Gn doses than luteal long protocol(P<0.05).The antagonist protocol had lower Gn doses and Gn days than luteal long protocol(both P<0.05).The incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS)was significantly lower in antagonist protocol than that in long protocol(P<0.05).There was no significant difference in embryo and pregnancy outcomes among the three groups(P>0.05).Conclusion The modified long protocol can improve endometrial receptivity without increasing the risk of OHSS,however,whether it can improve oocyte quality and pregnancy outcome still need further study.It can provide a choice for the treatment of patients with PCOS.