多囊卵巢综合征患者促排卵中不同干预措施预防卵巢过度刺激的效果  

Effects of different intervention measures in preventing ovarian hyper-stimulation to polycystic ovary syndrome patients during ovarian stimulation

作　　者：林佳[1] 朱如如 赵军招[1] 王佩玉[1] 肖仕全[1] 金聪聪[1] 

机构地区：[1]温州医科大学附属第一医院生殖医学中心,浙江温州325015 [2]温州医科大学附属第一医院妇科,浙江温州325015

出　　处：《温州医学院学报》2015年第7期519-524,共6页Journal of Wenzhou Medical College

基　　金：浙江省大学生科技创新活动计划(新苗人才计划)(2012R413047)

摘　　要：目的：探讨多囊卵巢综合征（PCOS）患者在体外受精-胚胎移植（IVF-ET）周期促排卵中运用不同干预措施预防卵巢过度刺激综合征（OHSS）的效果。方法：采用回顾性病例对照研究,将2011年1月至2013年12月本院124例行IVF-ET治疗并在超促排卵过程中出现OHSS倾向的PCOS患者分为3组：改行卵母细胞体外培养（IVM）组（n=46）,卵泡直径均≤12 mm时,停促性腺激素（Gn）,注射人绒毛膜促性腺激素（h CG）10 000 IU;h CG提前组（n=41）,继续促排卵,当有1个卵泡直径≥16 mm或至少3个卵泡直径≥14 mm时,注射h CG 4 000~6 500 IU;h CG减量组（n=37）,继续促排卵,当至少有1个卵泡的直径≥18 mm或2~3个卵泡的直径≥16 mm时,注射h CG 3 000~4 000 IU。比较各组实验室结果、临床结局及OHSS发生率。结果：改行IVM组总Gn用量及Gn天数显著少于其余2组,该组卵子成熟率、卵裂率、优质胚胎率均低于其余2组,差异有统计学意义（P〈0.05）。h CG提前组的h CG注射日≥14 mm卵泡数、优质胚胎率低于h CG减量组,其余各指标2组差异无统计学意义（P〈0.05）。改行IVM组无OHSS发生,另2组轻、中度OHSS发生率差异无统计学意义（P〉0.05）。3组临床妊娠率、胎儿活产率差异无统计学意义（P〈0.05）。结论：对于有OHSS倾向的PCOS患者,在IVF-ET周期促排卵过程中,可以采用改行IVM方案完全避免OHSS发生,而提前注射h CG与减量h CG方案均能避免重度OHSS的发生,在预防OHSS发生方面无明显差异。Objective： To investigate the effects of different intervention measures in preventing ovarian hyper-stimulation syndrome （OHSS） to polycystic ovary syndrome （PCOS） patients during ovarian stimulation of in vitro fertilization-embryo transfer （IVF-ET）.Methods： A retrospective case-control study was conduced from Jan. 2011 to Dec. 2013. 124 cycles of PCOS patients with high risk of OHSS in the process of ovarian stimula-tion underwent IVF were divided into three groups： converted IVM group （n=43）, when follicle diameter≤12 mm, stopped using gonadotropin （Gn）, then injected human chorionic gonadotropin （hCG） 10 000 IU; hCG early injection group （n=41）, went on stimulating, when there were more than one follicle diameter≥16 mm or more than three follicles diameter≥14 mm, injected hCG 4 000-6 500 IU; low-dose hCG group （n=37）, went on stimulating, when there were more than one follicle diameter≥18 mm or 2-3 follicles diameter≥16 mm, injected hCG 3 000-4 000 IU. Laboratory results, clinical outcomes and the incidence of OHSS were compared among three groups.Results： In converted IVM group, the total dose of gonadotrophin was lower and stimula-tion length was shorter than those of other two groups. The rate of oocyte maturation, cleavage, high quality embryos in converted IVM group were signiifcantly lower than other two groups （P〈0.05）. In hCG early injec-tion group, numbers of follicle≥14 mm on the hCG injection day were less and rate of good quality embryo was lower than in low-dose hCG group, and there were no difference with the rest indicators between the two groups.＆amp;nbsp;There was no OHSS occurrence in converted IVM group, mild to moderate OHSS incidence in other two groups was no signiifcant difference. There was no difference among three groups of clinical pregnancy rate and live birth rate.Conclusion： For the PCOS patients with high risk of OHSS during ovarian stimulation in IVF-ET, con-verted IVM from IVF could completely avoid OHSS. Otherwise

关 键 词：多囊卵巢综合征 卵巢过度刺激综合征 未成熟卵体外培养 hCG减量 限制性促排卵 

分 类 号：R711.6[医药卫生—妇产科学]