IVF-ET促排卵中卵巢过度刺激综合征高危患者的干预策略  

The effect of different strategies to prevent ovarian hyperstimulation syndrome in high-risk patients undergoing ovarian stimulation protocol in IVF

作　　者：滕依丽[1] 余蓉[1] 徐芝慧[1] 潘洁雪[1] 杨海燕[1] 黄学锋[1] TENG Yili;YU Rong;XU Zhihui;PAN Jiexue;YANG Haiyan;HUANG Xuefeng(Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015, China)

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

出　　处：《温州医科大学学报》2019年第1期6-10,共5页Journal of Wenzhou Medical University

基　　金：浙江省医药卫生科技计划项目(2017KY462);国家自然科学基金青年基金资助项目(81801411)

摘　　要：目的:探讨体外受精-胚胎移植(IVF-ET)促排卵中针对卵巢过度刺激综合征(OHSS)高危患者所采取的3种预防策略的有效性。方法:回顾性分析2015年1月至2016年7月在温州医科大学附属第一医院生殖医学中心行IVF促排卵5~7d后呈现卵巢高反应的OHSS高危患者178例的临床资料,根据所采用的干预策略不同分为3组。A组(低剂量HCG扳机组,n=95):继续给予促排卵用药,密切超声监测卵泡发育,直至卵泡成熟,给予较低剂量的HCG扳机;B组(小卵泡抽吸减灭组,n=23):超声引导下经阴道穿刺术减灭直径≤12mm的卵泡,之后继续促排卵用药至HCG扳机;C组(未成熟卵体外培养IVM组,n=60):停止继续促排卵用药,超声引导下经阴道穿刺术抽吸所有可见小卵泡,将卵泡液中卵丘-卵母细胞复合体分离后进行体外培养成熟。比较各组实验室结果、临床妊娠结局和OHSS发生率。结果:3组优质胚胎率、移植周期临床妊娠率以及活婴分娩率差异无统计学意义(P>0.05)。3组均无重度OHSS发生。轻、中度OHSS的发生率A组为50.53%,B组为34.78%,均显著高于C组(0%)(P<0.05),A组和B组间差异无统计学意义(P>0.05)。结论:对于IVF-ET促排卵中OHSS高危患者,采用低剂量HCG扳机、小卵泡抽吸减灭和未成熟卵体外培养均能完全避免发生重度OHSS,有效减少轻、中度OHSS的发生,同时3种干预策略都能带来较理想的妊娠结局。Objective: To investigate the effectiveness of three strategies to prevent ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing IVF cycles.Methods: Patients in group A (n=95) received decreased dose of HCG trigger.Patients in group B (n=23) were subjected to transvaginal aspiration of small follicles.Patients in group C (n=60) were subjected to in-vitro maturation (IVM).Results: No significant differences were detected in the rate of high-quality embryos,clinical pregnancy rate per-transfer and live birth delivery rate per transfer among 3 groups (P>0.05).No severe OHSS was observed in all patients.The incidence of mild-moderate OHSS was significantly higher in group A (50.53%) and B (34.78%),while none was observed in group C (0%).Conclusion: Transformation into IVM resulted in completely absence of OHSS.Follicle aspiration and decreased HCG trigger could both avoid severe OHSS and remarkably reduce the occurrence of mildmoderate OHSS.OHSS high risk patients could have ideal pregnancy outcomes with the above-mentioned three strategies.

关 键 词：卵巢高反应 卵巢过度刺激综合征 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]