超长方案中不同启动策略对多囊卵巢综合征患者IVF结局的影响  

Effect of different initiation regimens in ultra-long protocol on IVF outcome in patients with polycystic ovary syndrome

作　　者：熊巍[1] 廖莉婷 周远征[1] 孙正怡[1] 王含必[1] 甄璟然[1] 陶陶[1] 王雪[1] 桂婷[1] 肖亚玲[1] 邓成艳[1] 郁琦[1] XIONG Wei;LIAO Li-ting;ZHOU Yuan-zheng;SUN Zheng-yi;WANG Han-bi;ZHEN Jing-ran;TAO Tao;WANG Xue;GUI Ting;XIAO Ya-ling;DENG Cheng-yan;YU Qi(Department of Obstetrics & Gynecology,Peking Union Medical College Hospital,Peking Union Medical College/Chinese Academy of Medical Sciences,National Clinical Research Center for Obstetric & Gynecologic Diseases,Beijing 100730;Department of Obstetrics & Gynecology,the First People’s Hospital of Qinzhou,Qinzhou 535000)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,国家妇产疾病临床研究中心,北京100730 [2]钦州市第一人民医院妇产科,钦州535000

出　　处：《生殖医学杂志》2021年第6期715-720,共6页Journal of Reproductive Medicine

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者行IVF治疗时应用高纯度尿促性素(HP-HMG)联合重组人促卵泡生成素(rFSH)与单用rFSH启动卵巢刺激的临床结局。方法回顾性分析2017年10月至2019年9月在北京协和医院生殖中心行IVF助孕的96例PCOS患者的临床资料。所有患者应用3.75 mg长效GnRH激动剂降调节满意后卵巢刺激,根据启动药物不同将患者分为两组,HP-HMG+rFSH组:HP-HMG联合rFSH启动者49例;rFSH组:单用rFSH启动者47例。比较两组的胚胎发育情况、临床妊娠结局和卵巢过度刺激(OHSS)的发生率。结果rFSH组获卵数为(13.3±6.2)个显著高于HP-HMG+rFSH组(11.0±4.5)个(P<0.05);而HP-HMG+rFSH组的优胚率(13.5%vs.6.3%)和活产率(54.7%vs.32.4%)均显著高于rFSH组(P<0.05);两组间周期取消率和中重度OHSS发生率均无统计学差异(P>0.05)。结论PCOS患者应用超长方案时,HP-HMG联合rFSH启动卵巢刺激可显著提高优质胚胎比率、改善活产率,在降低OHSS风险方面与单用rFSH启动卵巢刺激的疗效相当。Objective:To compare the difference of clinical outcomes between administrations of high purity human gonadotropin(HP-HMG)combined with recombinant human FSH(rFSH)and rFSH alone for initiation of ovarian stimulation in patients with polycystic ovary syndrome(PCOS).Methods:The clinical data of 96 PCOS patients undergone IVF-ET in Peking Union Medical College Hospital from October 2017 to September 2019 were retrospectively analyzed.All patients were treated with 3.75 mg long-acting GnRH agonist down-regulation protocol,and ovarian stimulation was carried out after satisfactory down-regulation.The patients were divided into two groups according to the different initiation regimens:49 patients were started the ovarian stimulation by using HP-HMG combined with rFSH in HP-HMG+rFSH group,and 47 patients were started initiation with rFSH alone in rFSH group.The embryo development,clinical pregnancy outcome and the incidence of ovarian hyperstimulation(OHSS)were compared between the two groups.Results:The number of oocytes retrieved[(13.3±6.2)vs.(11.0±4.5)]in the rFSH group was significantly higher than that in the HP-HMG+rFSH group(P<0.05).The good-quality embryo rate(13.5%vs.6.3%)and live birth rate(54.7%vs.32.4%)in the HP-HMG+rFSH group was significantly higher than those in rFSH group(P<0.05).The cycle cancellation rates and the incidence of moderate and severe OHSS had no significant difference between the two groups(P>0.05).Conclusions:HP-HMG combined with rFSH for initiation of ovarian stimulation can significantly increase the good-quality embryos rate and improve the live birth rate in PCOS patients with ultra-long protocol.In terms of reducing OHSS risk,the efficacy of HP-HMG+rFSH regimen is similar to that of rFSH alone regimen for initiation of ovarian stimulation.

关 键 词：尿促性腺素 重组人促卵泡生成素 多囊卵巢综合症 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学] R711.75[医药卫生—临床医学]