高雄激素血症多囊卵巢综合征患者体外受精/卵细胞浆内单精子注射-胚胎移植助孕结局分析  

Effect of hyperandrogenism on pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

作　　者：江琳琳[1] 潘萍[1] 焦雪丹[1] 邱绮[1] 李予[1] 张清学[1] Jiang Linlin;Pan Ping;Jiao Xuedan;Qiu Qi;Li Yu;Zhang Qingxue(Reproductive Medicine Centre,Department of Obstetrics and Gynecology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院生殖中心,广州510120

出　　处：《中华医学杂志》2023年第14期1042-1048,共7页National Medical Journal of China

基　　金：国家自然科学基金(81971332,81901451)

摘　　要：目的分析高雄激素血症多囊卵巢综合征(PCOS)患者行体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的临床结局。方法本研究为横断面研究,选择2017年1月至2021年6月在中山大学孙逸仙纪念医院生殖中心行IVF/ICSI-ET助孕的PCOS患者的临床资料,共573例,将患者分为高雄激素血症组(HA组,191例)和非高雄激素血症组(NON-HA组,382例),按照拮抗剂方案和黄体期长方案分别采用1∶2倾向性评分匹配,用于平衡2组患者的女方年龄和受精方式,匹配后HA组191例,NON-HA组382例,比较2组患者的激素水平及妊娠结局等指标。结果HA组和NON-HA组患者的年龄分别为(29.6±3.7)和(29.5±3.6)岁(P=0.665)。与NON-HA组比较,HA组基础黄体生成素[(10.82±6.73)比(7.76±5.30)IU/L]、睾酮[(3.27±0.97)比(1.60±0.59)nmol/L]、游离雄激素指数(7.13比2.77)、抗苗勒管激素[(11.37±5.74)比(9.67±4.67)ng/ml]、0 h葡萄糖[(5.18±0.49)比(5.06±0.42)mmol/L]、1 h葡萄糖[(9.34±2.42)比(7.99±2.21)nmol/L]、2 h葡萄糖[(7.66±2.17)比(6.64±1.84)nmol/L]、2 h胰岛素[(129.81±145.49)比(97.51±86.92)mU/L]、总胆固醇[(5.35±0.89)比(4.92±0.92)mmol/L]、甘油三酯[(1.55±1.28)比(1.33±0.77)mmol/L]、低密度脂蛋白胆固醇[(3.38±0.66)比(3.14±0.71)mmol/L]均偏高,差异均有统计学意义(均P<0.05)。HA组促性腺激素启动剂量低于NON-HA组[(126.96±33.65)比(137.60±38.12)U](P=0.001),而2组患者中重度卵巢过度刺激综合征(OHSS)发生率差异无统计学意义(P>0.05)。同时,2组患者着床率、临床妊娠率、活产率和流产率差异均无统计学意义(均P>0.05)。结论高雄激素血症的PCOS患者生殖内分泌激素紊乱和糖脂代谢异常风险升高,在行IVF/ICSI助孕时,合适的促排卵治疗能获得与雄激素水平正常者相似的妊娠结局。Objective To explore the effects of hyperandrogenism(HA)on pregnancy outcomes in women with polycystic ovary syndrome(PCOS)undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods A retrospective study was conducted on infertile women with PCOS undergoing IVF/ICSI-ET from January 2017 to June 2021 in our center.Patients were divided into HA group and NON-HA group according to the levels of testosterone.Propensity score matching(PSM)was used to balance the influence of female age and IVF/ICSI-ET for patients with gonadotropin-releasing hormone(GnRH)antagonist protocol and GnRH agonist protocol,separately.After the PSM procedure,191 cases in HA group and 382 cases in NON-HA group,were included.Hormone levels and pregnancy outcomes were compared in the two groups.Results The female age was comparable in two groups[HA:(29.6±3.7)vs NON-HA:(29.5±3.6),P=0.665].The basal luteinizing hormone[(10.82±6.73)vs(7.76±5.30)IU/L],testosterone[(3.27±0.97)vs(1.60±0.59)nmol/L],free androgen index(7.13 vs 2.77),anti-mullerian hormone[(11.37±5.74)vs(9.67±4.67)ng/ml],fasting glucose[(5.18±0.49)vs(5.06±0.42)mmol/L],1h glucose[(9.34±2.42)vs(7.99±2.21)nmol/L],2 h glucose[(7.66±2.17)vs(6.64±1.84)nmol/L],2 h insulin[(129.81±145.49)vs(97.51±86.92)mU/L],total cholesterol[(5.35±0.89)vs(4.92±0.92)mmol/L],triglycerides[(1.55±1.28)vs(1.33±0.77)mmol/L],and low density lipoprotein cholesterol levels[(3.38±0.66)vs(3.14±0.71)mmol/L]were significantly higher in HA group,compared with NON-HA group(P<0.05).The initiated gonadotropin dose was higher in HA group than that in NON-HA group[(126.96±33.65)vs(137.60±38.12)U,P=0.001],but moderate-severe ovarian hyperstimulation syndrome(OHSS)rate was similar in two groups(P>0.05).The rates of implantation,clinical pregnancy,miscarriage,and live birth were comparable between the two groups(P>0.05).Also,in the subgroups,the rates of implantation,clinical pregnancy,live birth,and miscarriage were similar in HA group and NON-HA group.Conclusions

关 键 词：多囊卵巢综合征 高雄激素 体外受精-胚胎移植 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]