多囊卵巢综合征患者体外受精中促性腺激素释放激素拮抗剂方案安全性分析  

Security of gonadotropin-releasing hormone antagonist protocol in patients with polycystic ovary syndrome undergoing in vitro fertilization

作　　者：周红[1] 舒金辉[1] 甘贤优[1] 罗棹文 李霜[1] Zhou Hong;Shu Jinhui;Gan Xianyou;Luo Zhaowen;Li Shuang(Department of Reproductive Center, the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, Chin)

机构地区：[1]广西壮族自治区妇幼保健院生殖中心,南宁530003

出　　处：《中华生殖与避孕杂志》2018年第3期224-227,共4页Chinese Journal of Reproduction and Contraception

基　　金：广西卫生与计生委课题(Z2016093;Z20170777)~~

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者应用促性腺激素释放激素拮抗剂(GnRH-A)方案的可行性、安全性及预防中重度卵巢过度刺激综合征(OHSS)的方法。方法回顾性病例对照研究使用GnRH-A方案PCOS患者的304个取卵周期的临床资料。取卵后评估有无OHSS高风险,无OHSS风险者纳入A组,有OHSS高风险者纳入B组。比较患者的基本特征、促性腺激素(Gn)启动剂量及使用总量、Gn使用时间、获卵数、优质胚胎率、妊娠率、OHSS发生率等。结果 PCOS患者的年龄、体质量指数(BMI)、平均不孕年限组间比较差异均无统计学意义(P>0.05)的情况下,OHSS高风险与基础高黄体生成素(LH)、高LH/卵泡刺激素(FSH)、高睾酮(T)水平有关,组间比较差异均有统计学意义(P均=0.000)。A组进行新鲜移植共197个周期,临床妊娠率为58.89%(106/197)。B组行全部胚胎冷冻93个周期,首次冻融胚胎移植的临床妊娠率为81.81%(72/88)。分析可见,卵巢的反应性与启动日血清LH/FSH比值有相关性,LH/FSH比值越高,其促排卵的反应性就越好。总体中重度OHSS发生率为6.91%(21/304),A组的中重度OHSS发生主要是迟发型,与妊娠及多胎妊娠相关,B组的中重度OHSS发生主要是早发型。结论 GnRH-A方案应用于PCOS患者,可以通过减少启动剂量,新鲜周期移植前评估OHSS风险;如有OHSS风险者全部胚胎冷冻,期待冻融周期移植,可获得安全有效的结局。Objective To explore the feasibility and security of the gonadotropin-releasing hormone antagonist （GnRH-A） protocol and the prevention methods of the moderate-severe ovarian hyperstimulation syndrome （OHSS） in polycystic ovary syndrome （PCOS） patients. Methods The clinical data of 304 oocyte retrieval cycles undergoing GnRH-A protocol in PCOS patients were retrospectively analyzed. According to whether high risk of OHSS after oocyte retrieval, 304 oocyte retrieval cycles were divided into low risk of OHSS group （group A, 197 cycles） and high risk of OHSS group （group B, 93 cycles）. We analyzed the basic characteristic, the initial and total dosage of gonadotropin （Gn） used, the duration of Gn used, the number of retrieved oocytes, rate of high-quality embryos, clinical pregnancy rate, the incidence of OHSS, etc. Results The high risk of OHSS was related to high basic luteinizing hormone （LH）, high ratio of LH and follicle-stimulating hormone （LH/FSH） and high level of testosterone （T）, when there were no statistical significances in ages, basic mass index （BMI）, and the duration of infertility among patients with PCOS （P〉0.05）. Group A was treated with fresh embryo transfer, and the clinical pregnancy rate was 58.89% （106/197）. Group B was treated with all embryos vitrified, and the clinical pregnancy rate of first frozen-thawed embryo transfer cycle was 81.81% （72/88）. Comparing the two groups, there was a positive relation between the ovarian reactivity and LH/FSH on the initial day of Gn used. Overall, the accidence rate of moderate-severe OHSS was 6.91% （21/304）. The moderate- severe OHSS in group A was mainly delayed type, which was related to singleton or multiple pregnancy. While the moderate-severe OHSS in group B was mainly early-onset type. Conclusion Reducing the initial dose of Gn used, assessing the properly occurrence rate of OHSS before flesh embryo transferation, GnRH-A protocol is suitable and secure for PCOS population. Patients with hig

关 键 词：促性腺激素释放激素拮抗剂(GnRH—A) 多囊卵巢综合征(PCOS) 体外受精(IVF) 卵巢过度刺激综合征(OHSS) 

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