不同体质量指数的PCOS患者行长方案促排卵的体外授精结局对比分析  

In vitro fertilization outcomes of PCOS patients with different body mass indexes who received the long-protocol ovarian stimulation

作　　者：孙玉红 黎淑贞[1] 黎平[1] Sun Yuhong;Li Shuzhen;Li Ping(Department of Reproductive Center,Jiangmen Central Hospital,Jiangmen 529030,China)

机构地区：[1]江门市中心医院生殖中心,529030

出　　处：《国际医药卫生导报》2020年第22期3431-3435,共5页International Medicine and Health Guidance News

摘　　要：目的探讨体质量指数(BMI)对在IVF-ET中行长方案促排卵的PCOS患者的影响。方法回顾性分析2016年1月至2019年5月期间本院生殖专科新鲜周期采用长方案促排的PCOS患者464例临床资料,根据患者BMI分为三组,低BMI组(BMI<18.5 kg/m^2),正常BMI组(18.5 kg/m^2≤BMI<24.0 kg/m^2),高BMI组(BMI≥24.0 kg/m^2);比较各组间基础情况、促排情况及其妊娠结局。结果随着BMI的升高,PCOS患者的不孕年龄增大,不孕年限延长,FSH、LH均呈现逐渐下降趋势,差异均有统计学意义(均P<0.05);Gn启动量随着BMI的升高显著上升,高BMI组Gn天数最长,Gn用量最高,差异均有统计学意义(均P<0.05);三组患者HCG日E2、获卵数、MII卵率、可利用卵裂期胚胎数、优胚率比较,差异均无统计学意义(均P>0.05);高BMI组囊胚形成率最低,差异有统计学意义(P<0.05);正常BMI组囊胚形成率与低BMI组比较,差异均无统计学意义(均P>0.05);三组临床妊娠率、流产率、活产率、中重度OHSS发生率、早产率、平均出生孕周、新生儿出生体质量比较,差异均无统计学意义(均P>0.05);高BMI组胚胎种植率最低、生化妊娠率最高,差异均有统计学意义(均P<0.05);正常BMI组胚胎种植率、生化妊娠率与低BM组比较,差异均无统计学意义(均P>0.05);同时随着BMI的升高,剖宫产率在逐渐上升。结论瘦型PCOS对IVF妊娠结局无明显影响,相反,高BMI的PCOS患者行IVF助孕所需Gn天数更长,用量更大,囊胚形成率和胚胎种植率均明显下降,生化妊娠率明显升高,虽然临床妊娠率和活产率未显示出显著性差异,但随着BMI的升高,均呈现出逐渐下降趋势;同时随着BMI的升高,有着更高的剖宫产率。因此,在临床工作中对于肥胖PCOS患者的BMI控制应予以重视,建议在进入IVF助孕前适当降低BMI,有助于改善临床妊娠结局。Objective To investigate the effect of body mass index(BMI)on PCOS patients undergoing long-protocol ovarian stimulation in IVF-ET.Methods 464 PCOS patients who were treated with the long-protocol ovarian stimulation in fresh cycle in the Department of Reproductive Medicine of our hospital from January,2016 to May,2019 were analyzed retrospectively.According to their BMI,the patients were divided into a low BMI group(BMI<18.5 kg/m^2),a normal BMI group(18.5 kg/m^2≤BMI<24.0 kg/m^2),and a high BMI group(BMI≥24.0 kg/m^2).The baseline characteristics,ovarian stimulation and pregnancy outcomes were compared between the 3 groups.Results With the increase of BMI,the patients'age increased,their infertility duration prolonged,and their FSH and LH levels gradually decreased(all P<0.05).The Gn increased with BMI;the Gn time was the longest and the Gn dosage was the highest in the high BMI group(all P<0.05).There were no statistical differences in E2 levels on the HCG trigger day,retrieved oocytes,MII oocyte rate,available embryos in cleavage stage,and top quality embryo rate between the 3 groups(all P>0.05).The blastocyst formation rate was the lowest in the high BMI group(P<0.05);and there was no statistical difference in the rate between the normal BMI group and the low BMI group(P>0.05).There were no statistical differences in clinical pregnancy rate,abortion rate,live birth rate,incidence of moderate or severe OHSS,preterm delivery rate,mean gestational age,and newborn birth weight between the 3 groups(P>0.05).The high BMI group had the lowest embryo implantation rate and the highest biochemical pregnancy rate(all P<0.05);and there were no statistical differences in the implantation rate and the highest biochemical pregnancy rate between the normal BMI group and the low BMI group(both P>0.05).The cesarean section rate gradually increased the BMI.Conclusions Thin patients with PCOS have similar IVF pregnancy outcomes with PCOS patients with normal BMI.On the contrary,PCOS patients with high BMI undergoing IVF need m

关 键 词：体质量指数 多囊卵巢综合征 长方案促排卵 妊娠结局 

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