PCOS患者BMI对因预防OHSS周期取消率的影响

Impact of body mass index on cycle cancellation rate in patients with PCOS

目的探究多囊卵巢综合征(PCOS)患者在超促排卵周期中,体重指数(BMI)对因预防OHSS取消新鲜胚胎移植(简称周期取消)的影响。方法本研究为回顾性队列研究,分析2016—2018年在本中心就诊的719例PCOS患者的临床资料。根据BMI值(亚洲标准)分为低体重组(BMI<18.5 kg/m^(2)),正常体重组(18.5≤BMI<24 kg/m^(2)),超重组(24≤BMI<28 kg/m^(2)),肥胖组(BMI≥28 kg/m^(2))4组,同时以不同促排卵方案分为GnRH-a长方案亚组和GnRH-A拮抗剂方案亚组,探究各组女性BMI对周期取消的独立影响作用。结果多元回归分析发现,肥胖组和低体重组相比发现,肥胖组移植取消可能性显著降低(OR 3.61;95%CI:0.84~15.54);与低体重组相比,超重组和正常体重组移植取消可能性呈下降趋势(OR 2.33;95%CI:0.56~9.75)、(OR 1.76;95%CI:0.46~6.80)。进一步分层分析提示,在长方案组,与低体重组相比,超重组移植取消可能性明显降低(OR 2.86;95%CI:1.29~6.33),肥胖组和低体重组相比,移植取消可能性亦明显降低(OR 2.77;95%CI:1.16~6.63),有统计学意义;在拮抗剂组,和低体重组相比,超重组及肥胖组移植取消可能性呈下降趋势(OR 2.31;95%CI:0.65~8.25)、(OR 1.83;95%CI:0.48~6.99)。结论PCOS患者中,BMI越低周期取消的可能性越高,这种趋势在长方案组更明显,差异有统计学意义,而拮抗剂组则不明显。因此,PCOS患者在选择促排卵治疗方案时,除了常规考虑患者卵巢功能,年龄等情况,女性BMI也是需要考虑的因素。

Objective To explore the impact of body mass index(BMI)on cancellation of embryo transfer(hereinafter referred to as cycle cancellation)due to preventing OHSS during controlled ovarian hyperstimulationin patients with PCOS.Methods This study was a retrospective cohort study.The clinical data of 719 patients with PCOS who were treated in our center from^(2)016 to 2018 were analyzed.According to the BMI(Asian standard),the patients were divided into four groups:low body weight group(BMI<18.5 kg/m^(2)),normal body weight group(18.5≤BMI<24 kg/m^(2)),super-combined group(24≤BMI<28 kg/m^(2))and obese group(BMI≥28 kg/m^(2)).They were divided into GnRH-a long program subgroup and GnRH-A antagonist program subgroup to explore the independent effect of BMI on cycle cancellation in each group.Results Compared to the underweight group,the multivariate regression analysis found that the obese group transplantation cancellation is significantly reduced(β3.61;95%CI:0.84-15.54),while overweight group and normal weight group showed a reduced trend(OR 2.33;95%CI:0.56~9.75),(OR 1.76;95%CI:0.46-6.80).Compared to the underweight group,stratification analysis revealed that overweight and obese group treated with the GnRH-a agonist was significantly reduced(OR 2.86;95%CI:1.29-6.33),(OR 2.77;95%CI:1.16-6.63),while overweight group and obese group were showed a reduced trend also(OR 2.31;95%CI:0.65-8.25),(OR 1.83;95%CI:0.48-6.99).Conclusion Among the PCOS patients,the lower the BMI,the higher the cycle cancellation rate,and this trend is more obvious in GnRH-a agonist group.Thus,when choosing an COH protocol,in addition to the patient′s ovarian function,age,etc.,female BMI is also a factor that needs to be considered.