高AMH水平PCOS与非PCOS患者新鲜胚胎移植妊娠结局比较

Comparison of pregnancy outcomes of fresh embryo transfer between PCOS and non-PCOS patients with high AMH levels

目的:比较高抗苗勒管激素(AMH)水平多囊卵巢综合征(PCOS)与非PCOS患者新鲜胚胎移植后的妊娠结局。方法:回顾分析2017年5月1日至2020年5月1日于郑州大学第三附属医院生殖医学中心行新鲜胚胎移植高AMH水平患者的临床资料,共656个周期,根据是否合并PCOS分为PCOS组与非PCOS组。比较两组患者的临床和实验室相关指标。按移植结局将患者分为妊娠组及未妊娠组,比较两组患者的临床资料,并采用二元逻辑回归分析影响临床妊娠的因素。结果:非PCOS组的获卵数、2PN受精率高于PCOS组(P=0.048、P=0.035),卵巢过度刺激综合征(OHSS)发生率低于PCOS组(P=0.031)。妊娠组患者的年龄、Gn总用量及Gn启动量均低于未妊娠组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄、Gn启动量是临床妊娠的独立影响因素(P=0.047、P=0.024)。结论:高AMH水平下,PCOS患者与非PCOS患者能获得相当的妊娠率和活产率,PCOS患者发生OHSS的风险更高,适当降低Gn启动量可能获得更好的妊娠结局。

Objective:To compare the pregnancy outcomes of fresh embryo transfer between polycystic ovarian syndrome(PCOS)and non-PCOS patients with high anti-mullerian hormone(AMH)levels.Methods:The data of 656 fresh embryo transfer cycles with high AMH levels were analyzed retospectively from May 1,2017 to May 1,2020 in the Center for Reproductive Medicine of the Third Affiliated Hospital of Zhengzhou University.The patients were divided into PCOS group and non-PCOS group according to whether they had PCOS or not.The clinical and laboratory indicators of patients in the two groups were compared and analyzed.According to the pregnancy outcomes,patients were divided into pregnancy group and non-pregnancy group.The clinical data of the two groups were compared,and the influencing factors of clinical pregnancy outcomes were analyzed by binary logistic regression.Results:The number of retrieved oocytes and 2PN fertilization rate in non-PCOS group were higher than those in PCOS group(P=0.048,P=0.035).The incidence of ovarian hyperstimulation syndrome(OHSS)in PCOS group was significantly higher than that in non-PCOS group(P=0.031).The age of the pregnancy group was lower than that of the non-pregnancy group(P=0.047),and the total dosage of Gn used and starting dosage of Gn in the non-pregnancy group were higher than those in the pregnancy group(P<0.05).Logistic regression analysis showed that age and starting dosage of Gn were independent influencing factors for clinical pregnancy(P=0.047,P=0.024).Conclusion:At high AMH levels,PCOS patients and non-PCOS patients can achieve similar pregnancy and live birth rates,PCOS patients have a higher risk of OHSS,and appropriate reduction of the starting dosage of Gn may lead to better pregnancy outcomes.