多囊卵巢综合征患者不同超促排卵方案助孕的结果分析  

Effect of different ovulation induction regimens for polycystic ovary syndrome

作　　者：欧阳密霞[1] 阳翎[1] 唐慧珍[1] 周娜 任莎[1] 禹虹[1] Ouyang Mixia;Yang Ling;Tang Huizhen;Zhou Na;Ren Sha;Yu Hong(Center for Reproductive Medicine,Hunan Provincial Maternal and Child Health Care Hospital(Hunan Institute of Reproductive Medicine),Changsha 410008,China)

机构地区：[1]湖南省妇幼保健院(湖南省生殖医学研究院)生殖中心,长沙410008

出　　处：《中国医师杂志》2022年第8期1184-1187,1192,共5页Journal of Chinese Physician

基　　金：湖南省自然科学基金(2019JJ80038);湖南省出生缺陷协同防治重大科技专项生殖细胞异常导致出生缺陷的机制研究(2019SK1012)。

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者采用不同超促排卵方案助孕的结局。方法回顾性分析湖南省妇幼保健院生殖中心2016年9月1日至2020年7月31日行体外受精-胚胎移植助孕共1032例PCOS患者的助孕情况。根据患者不同超促排卵方案分为改良长方案组(A组126例)、黄体期长方案组(B组185例)、拮抗剂方案组(C组344例)、高孕激素促排卵方案组(D组377例)。比较各组患者的促排卵情况[促性腺激素(Gn)使用天数、Gn使用总量、注射人绒毛膜促性腺激素(HCG)日雌二醇(E2)水平、获卵数、成熟卵(MII卵)数、正常受精胚胎(2PN)数、优质胚胎数]和首次冻胚移植妊娠情况(临床妊娠率、着床率、早期流产率)。结果(1)四组患者的一般临床资料差异无统计学意义(均P>0.05)。(2)D组患者Gn使用天数明显少于A、B、C组,Gn使用总量明显少于A、B、C组,差异有统计学意义(均P<0.05);C组和D组患者注射HCG日E2水平明显低于A、B组,差异有统计学意义(均P<0.05);C组、D组获卵数、MII卵数明显少于A组、B组,差异有统计学意义(均P<0.05);D组患者优质胚胎数、2PN数与A组、B组、C组间差异有统计学意义(均P<0.05)。(3)A组、B组、C组和D组的患者全胚胎冻存后第一次冻胚移植临床妊娠率分别为54.72%(29/53)、56.79%(46/81)、52.56%(82/156)和54.32%(195/359),四组间差异无统计学意义(均P>0.05)。四组患者胚胎着床率、早期流产率差异均无统计学意义(均P>0.05)。结论PCOS患者予改良长方案、黄体期长方案、拮抗剂方案、PPOS方案均能获得较好的妊娠结局。其中PPOS方案超促排卵可以减少Gn用量和时间,冻胚移植不影响患者的妊娠结局,对于拟行冻胚移植的PCOS患者,可以作为优先推荐的策略之一。Objective To explore effects of controlled ovarian stimulation(COS)protocols on pregnancy outcomes for patients with polycystic ovarian syndrome(PCOS)undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods A total of 1032 patients with PCOS who underwent IVF-ET from September 1,2016 to July 31,2020 in the Reproductive Center of Hunan Provincial Maternal and Child Health Care Hospital were retrospectively analyzed.The patients were divided into modified long regimen group(group A,126 cases),luteal phase long regimen group(group B,185 cases),antagonist regimen group(group C,344 cases),and progestin primed ovarian stimulation(PPOS)group(group D,377 cases)according to different ovulation stimulation regimens.The ovulation promotion status[days of gonadotropin(Gn),total amount of Gn,estradiol(E2)level on the day of human chorionic gonadotropin(HCG)injection,number of retrieved eggs,number of mature eggs(MII eggs),number of normal fertilized embryos(2PN),number of high-quality embryos]and the first frozen embryo transfer pregnancy status(clinical pregnancy rate,implantation rate,early abortion rate)were compared among the patients in each group.Results(1)There was no significant difference in general clinical data between the four groups(all P>0.05).(2)The number of Gn days in group D was significantly less than that in groups A,B and C,and the total number of Gn was significantly less than that in groups A,B and C(all P<0.05);The E2 level of patients in group C and group D on the day of hCG injection was significantly lower than that of group A and group B(all P<0.05);The number of eggs obtained and MII eggs in group C and group D were significantly lower than those in group A and group B(all P<0.05);The number of high-quality embryos and 2PN in group D were significantly different from those in group A,group B and group C(all P<0.05).(3)The clinical pregnancy rates of the first frozen embryo transfer after whole embryo cryopreservation in group A,group B,group C and group D were 54.72%(29/53),56.79%(46/81),

关 键 词：多囊卵巢综合征 体外受精 胚胎移植 超排卵 妊娠结局 

分 类 号：R711.75[医药卫生—妇产科学]