多囊卵巢综合征患者体外受精或卵细胞质内单精子注射的不同超促排卵方案比较

Comparison of different superovulation protocols for in vitro fertilization or intra cytoplasmic sperm injection in patients with polycystic ovary syndrome

目的:探讨黄体期短效促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRH-a)长方案、卵泡期GnRH-a长方案以及促性腺激素释放激素拮抗剂(gonadotropin releasing hormone antagonist,GnRH-ant)方案3种超促排卵方案在进行体外受精或卵细胞质内单精子注射-胚胎移植(in vitro fertilization/intra cytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)治疗的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者中的应用价值。方法:回顾性分析2017年1月—2020年12月在汕头大学医学院第一附属医院接受IVF/ICSI-ET治疗的PCOS患者293个周期的临床资料,根据超促排卵方案分为黄体期短效GnRH-a长方案组(A组,48个取卵周期),卵泡期GnRH-a长方案组(B组,108个取卵周期),GnRH-ant方案组(C组,137个取卵周期)。分析3组患者的超促排卵情况以及临床治疗结局。结果:B组和C组的促性腺激素(gonadotropin,Gn)启动量低于A组(P值均<0.05);C组的Gn使用时间最短、Gn使用总量最少(P值均<0.05);B组人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日的血清雌二醇水平低于A组和C组(P值均<0.05);C组HCG注射日的内膜厚度低于A组和B组(P值均<0.05)。3组的获卵数、可利用胚胎数、优胚率、移植胚胎数、临床妊娠率、胚胎种植率、早期流产率、异位妊娠率、中重度卵巢过度刺激综合征发生率、全胚冷冻率及活产率差异无统计学意义(P值均>0.05)。结论:GnRH-ant方案具有总Gn用量少、Gn刺激时间短等优势。

Objective: To investigate the effects of three superovulation protocols of luteal phase short-acting gonadotropin releasing hormone(GnRH) agonist long-term protocol, follicular phase GnRH agonist long-term protocol, and GnRH antagonist protocol in patients with polycystic ovary syndrome(PCOS) treated with in vitro fertilization or intra cytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET). Methods: The clinical data of 293 cycles of PCOS patients who received IVF/ICSI-ET in the First Affiliated Hospital of Shantou University Medical College from January 2017 to December 2020 were retrospectively analyzed. The patients were divided into luteal phase short-acting GnRH agonist long-term protocol group(group A, 48 cycles), follicular phase GnRH agonist long-term protocol group(group B, 108 cycles), and GnRH antagonist protocol group(group C, 137 cycles)according to the superovulation protocols. The superovulation conditions and clinical treatment outcomes of the three groups of patients were analyzed. Results: The starting amount of gonadotropin(Gn) in groups B and C was lower than that in group A(all P<0.05);group C had the shortest use time of Gn and the least total amount of Gn(all P<0.05);the level of estradiol on the day of human chorionic gonadotropin(HCG) injection in group B was lower than that in groups A and C(both P<0.05);the endometrial thickness of group C on the day of HCG injection was lower than that in groups A and B(both P<0.05). There was no significant difference in the number of oocytes retrieved, the number of available embryos, the rate of good quality embryos, the number of transferred embryos,the clinical pregnancy rate, the embryo implantation rate, the early abortion rate, the ectopic pregnancy rate, the incidence of moderate to severe ovarian hyperstimulation syndrome, whole embryo freezing rate and live birth rate in the three groups(all P>0.05). Conclusion: The GnRH antagonist protocol has the advantages of less total Gn dosage and shorter Gn stimulation time.