多囊卵巢综合征体外受精-胚胎移植妊娠结局及其影响因素分析  

Effects of polycystic ovarian syndrome on in vitro fertilization-embryo transfer outcomes

作　　者：曾晓霞[1] 刘风华[1] 杜红姿[1] 龙晓林[1] 张文红[1] 黄玉玲[1] 刘怡潼[1] 

机构地区：[1]广州医学院第三附属医院生殖医学中心,广东广州510150

出　　处：《中国实用妇科与产科杂志》2010年第12期929-932,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨多囊卵巢综合征(PCOS)不育患者行体外受精-胚胎移植(IVF-ET)的治疗效果及其影响因素。方法对2006年3月至2009年3月在广州医学院第三附属医院生殖医学中心行IVF的PCOS不孕患者作回顾性分析,观察组(A组)为PCOS不孕患者120例132周期,对照组(B组)为双侧输卵管梗阻不孕患者343例382周期,比较两组HCG日雌二醇(E2)、获卵数、受精率、优质胚胎数、种植率、临床妊娠率、活产率、周期取消率、卵巢过度刺激综合征(OHSS)发生率。PCOS患者根据BMI分为正常体重组(C组)及超重组(D组),比较两组妊娠结局。结果 A、B两组促性腺激素(Gn)用量及HCG日E2水平、每移植周期临床妊娠率、流产率、活产率差异无统计学意义(P>0.05);A组与B组比较Gn用时较长,获卵数较多,受精率、卵裂率较高,优质胚胎数较多,种植率较低,OHSS发生率、周期取消率较高,差异有统计学意义(P<0.05)。D组与C组比较,Gn总量较多、用时较长,HCG日E2峰值较低,获卵数、优质胚胎数较少,受精率较低,差异有统计学意义(P<0.05);种植率较低,流产率、周期取消率及OHSS发生率较高,但差异无统计学意义(P>0.05)。结论 IVF-ET是PC0S不孕患者的一种有效治疗方法,但应积极预防OHSS;肥胖及胰岛素抵抗可能对妊娠结局产生不良影响。Objective To evaluate the effect of polycystic ovary syndrome（PCOS）,a marker of the metabolic syndrome,on selected indicators of in vitro fertilization（IVF）treatment success.Methods A retrospective cohort study was conducted using existing data on 132 IVF treatment cycles undergone by PCOS women and 382 IVF treatment cycles undergone by tubal infertility.Both groups underwent IVF-ET treatment between 2006 and 2009 in our IVF center.The PCOS group was divided into two subgroups as lean and overweight groups according to their body mass index.The duration of stimulation,amps of Gn,the level of serum E2 on the day of HCG injection,the number of oocytes retrieved,the rates of fertilization,implantation,pregnancy and miscarriage,the occurrence of ovarian hype stimulation syndrome（OHSS）and cancellation were compared between the two groups and subgroups of PCOS women.Results Amps of Gn,the level of serum E2 on the day of HCG injection,the rates of pregnancy,miscarriage and live birth were no difference between the two groups,but PCOS group had longer duration of stimulation,more oocytes retrieved,higher fertility rate,more high-quality embryos,lower implantation rate,higher occurrence of OHSS and cancellation than non-PCOS group.Between the two subgroups of PCOS women,overweight group required more Gn doses,longer duration of stimulation,lower serum E2 on the day of HCG injection,less oocytes retrieved and high-quality embryos,lower fertility rate than lean PCOS with significant difference.Conclusion IVF-ET is an effective management for the infertile patients with PCOS after the conventional methods have failed to be conceived.Patients with PCOS with a body mass index（BMI）in the lean rather than the obese have more favorable assisted reproductive technology（ART）cycle characteristics but show no clinical outcome difference,obesity and insulin resistance may have an adverse impact on IVF outcome.

关 键 词：多囊卵巢综合征 不孕 体外受精-胚胎移植 肥胖 胰岛素抵抗 妊娠结局 

分 类 号：R71[医药卫生—妇产科学]