小卵泡穿刺联合GnRH拮抗剂在PCOS患者的IVF-ET效果分析  

Analysis the Effectiveness of Small Follicle Puncture with GnRH Antagonist in Polycystic Ovarian Syndrome During IVF-ET Cycle

作　　者：应映芬[1] 卢晓声[1] 杨榃楚 姜振[1] 张慧娜[1] 程静[1] 

机构地区：[1]温州医科大学附属第二医院生殖中心,325027 [2]温州医科大学,325000

出　　处：《医学研究杂志》2017年第12期81-84,共4页Journal of Medical Research

基　　金：浙江省温州市科技局科技计划项目(Y20150213)

摘　　要：目的探讨超促排卵过程中经阴道超声下小卵泡穿刺联合Gn RH拮抗剂对多囊卵巢综合征(PCOS)患者的疗效。方法选取2013年6月~2016年6月在笔者中心行体外受精-胚胎移植(IVF-ET)超促排卵过程中卵泡发育数量过多的PCOS患者139例141周期,其中实验组(小卵泡穿刺联合Gn RH拮抗剂)60例62个周期,对照组79例79个周期(按临床常规减量Gn或卵泡成熟日根据E2水平行coasting治疗)。比较两组的一般情况、日Gn最大量、Gn使用天数、Gn总用量、获卵数、成熟率、受精率、卵裂率以及OHSS发生率、取消移植率、临床妊娠率等数据。结果两组患者的年龄、体重指数、不孕年限以及基础内分泌差异无统计学意义(P均>0.05)。实验组日Gn最大量较对照组显著减少(P<0.01),实验组的Gn天数、扳机日E2水平和扳机日≥10mm卵泡个数减少,较对照组差异有统计学意义(P均<0.05),实验组获卵数较对照组显著减少(P=0.000)。实验组的卵子成熟率和优胚率较对照组显著增加(P均<0.01)。实验组的中重度OHSS发生率和取消移植率显著减少(P均<0.01),实验组的临床妊娠率和持续妊娠率较对照组增加,差异有统计学意义(P均<0.05)。结论经阴道超声下小卵泡穿刺联合Gn RH拮抗剂是一种有效解决PCOS患者超促排卵过程中过多卵泡发育问题的手段,可以显著降低中重度OHSS的发生率,改善卵子成熟率和优胚率,提高IVF-ET的临床结局。Objective To evaluate the effectiveness of small follicle puncture with GnRH antagonist in polycystic ovarian syndrome during IVF-ET cycle.Methods Totally 139 women of polycystic ovarian syndrome, accepted IVF-ET treatment during the period from June 2013 to June 2016 in our reproductive center, were analyzed retrospectively which contained 60 patients in experimental group and 79 infertile females in control group. The basal characteristics, largest Gn dosage, Gn duration, total dosage of Gn, the number of retrieved oocytes, the rates of maturity, fertilization and cleavage and so on in both group were compared.Results There were no significant differences in the average age, BMI, infertility duration and basal hormone level between both groups （all P〉0.05）. The largest dosge of Gn was more in control group （P〈0.01）. Gn duration, estrogen level on the day of hCG and number of ≥ 10mm oocytes were all less than those in control group （all P〈0.05）. The number of oocyte retrieved was much less in experimental group （P=0.000）. The rates of oocyte maturity and optimistic quality embryos were better than those in control group （both P〈0.01）. The incidence of severe OHSS and cancel rate of embryo transfer were less in experimental group （both P〈0.01）. The rates of clinical pregnancy and ongoing pregnancy were better in the experimental group （both P〈0.05）.Conclusion Small follicle puncture together with GnRH antagonist can effectively reduce the incidence of severe OHSS and improve the outcomes of IVF-ET cycles.

关 键 词：多囊卵巢综合征 小卵泡穿刺术 GNRH拮抗剂 体外受精-胚胎移植 卵巢过度刺激综合征 

分 类 号：R711.6[医药卫生—妇产科学]