诱发日内源性孕酮升高对PCOS患者的IVF/ICSI临床结局的影响  

Effect of elevated progesterone on the trigger day on the clinical outcomes in polycystic ovary syndrome patients undergoing IVF/ICSI treatment

作　　者：叶红娟[1,2] 陈秋菊[1] 何雯[1] 叶静[1] 朱秀娴[1] 匡延平[1] 

机构地区：[1]上海交通大学医学院附属上海第九人民医院辅助生殖科,上海200011 [2]上海交通大学医学院九院临床医学院,上海200011

出　　处：《生殖与避孕》2016年第9期712-718,共7页Reproduction and Contraception

基　　金：国家自然科学基金项目;项目编号(81571397);上海市科委项目;项目编号(15411953000)

摘　　要：目的:在高孕激素超促排卵(progestin-primed ovarian stimulation,PPOS)及全胚胎冷冻移植的背景下,探讨诱发排卵日内源性孕酮(P)水平与多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)临床结局的关系。方法:回顾性纳入180例PCOS患者行IVF/ICSI-冻融胚胎移植(FET)的资料,所有患者均采用促性腺激素(gonadtropin,Gn)联合孕激素的超促排卵方案,取卵后全部胚胎冷冻,择期行FET,根据诱发排卵日P水平分为A组(P<1.0μg/L,n=125)和B组(P≥1.0μg/L,n=55),比较两组患者的促排卵结局和妊娠结局。结果:A组与B组的Gn总用量(1950.8±384.5 IU vs 1931.2±308.9 IU)及周期治疗时间(11.2±1.4 d vs 11.1±1.1 d)均无统计学差异(P>0.05)。A组诱发日直径>14 mm卵泡数(14.1±7.7 vs21.0±10.3)、获卵数(14.0±7.8 vs 24.1±10.3)、成熟卵数(12.1±7.1 vs 21.1±9.0)、正常受精卵数(9.8±6.1 vs 16.8±8.2)及冷冻胚胎数(5.3±3.6 vs 7.2±3.4)均较B组低,且差异均具有统计学意义。成熟卵率、正常受精卵率、周期取消率、临床妊娠率及种植率组间均无统计学差异(P>0.05)。结论:在FET的前提下,高孕激素超促排卵过程中诱发日内源性P水平的升高提示卵巢反应良好,对PCOS患者的IVF/ICSI临床结局无明显影响。Objective： To explore the effects of elevated progesterone （P） level on the trigger day undergoing the progestin-primed ovarian stimulation （PPOS） protocol combined with embryo cryopreservation on in vitro fertilization/intracytoplasmic sperm （IVF/ICSI） clinical outcomes in the patients with polycystic ovary syndrome （PCOS）. Methods： A total of 180 patients diagnosed with PCOS according to Rotterdam criteria undergoing PPOS protocol were analyzed in this retrospective study and were divided into two groups according to the P levels on the trigger day： group A, P〈1.0μg/L, group B, P≥1.μg/L. Gonadotropins （Gn） and medroxyprogestrone acetate （MPA） were used from the early follicle phase. The IVF embryological characteristics and the pregnancy results after frozen-thawed embryo transfer （FET） were compared between the two groups. Results： There was no significant difference in Gn dose （1 950.8±384.5 IU vs 1 931.2 ±308.9 1U, P〉0.05） and stimulation duration （11.2 ± 1.4 d vs 11.1±1.1 d, P〉0.05） between the two groups. The number of follicles with diameter〉14 mm on the trigger day （14.1±7.7 vs 21.0±10.3）, oocytes retrieved （14.0±7.8 vs 24.1±10.3）, mature oocytes （12.1±7. 1 vs 21.1±9.0）, fertilization oocytes （9.8±6.1 vs 16.8±8.2） and frozen embryos （5.3± 3.6 vs 7.2±3.4） were significantly decreased in group A compared with group B. However, there was no significant difference in the mature oocyte rate, the fertilization rate and the cancellation rate between the two groups. No significant differences were identified in the implantation rate （46.92% vs 45.38%, P〉0.05） and the clinical pregnancy rate （63.43% vs 62.29%, P〉0.05） per FET cycle between group A and group B, respectively. Conclusion： The pregnancy outcome of PCOS patients was not impacted, although they were at a status of elevated P level on the trigger day, which indicates a good ovarian response in the PPOS combined with embryo cryopreservation.

关 键 词：多囊卵巢综合征(Pcos) 诱发日孕酮 体外受精/卵胞质内单精子显微注射(IVF/ICSI) 

分 类 号：R711.75[医药卫生—妇产科学] R714.8[医药卫生—临床医学]