不同促排卵方案在多囊卵巢综合征患者中的应用比较  

Comparison of different controlled ovarian stimulation protocols in patients with polycystic ovary syndrome

作　　者：周立花 胡英[1] 邹晖[1] 李浩僡 郝佳渊 李娟[1] ZHOU Li-hua;HU Ying;ZOU Hui;LI Hao-hui;HAO Jia-yuan;LI Juan(Department of Reproductive Medicine,the Second Affiliated Hospital of Hainan Medical University,Haikou 570100)

机构地区：[1]海南医学院第二附属医院生殖医学科,海口570100

出　　处：《生殖医学杂志》2023年第4期529-535,共7页Journal of Reproductive Medicine

基　　金：海南省自然科学基金项目(821RC711)。

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕时不同促排卵方案的特征及妊娠结局。方法回顾性分析2018年1月至2021年10月于本院行IVF/ICSI-ET助孕的PCOS患者共442个周期的临床资料。根据促排卵方案不同分为长效长方案组(174个周期)、卵泡期长方案组(113个周期)、改良超长方案组(59个周期)和拮抗剂方案组(96个周期),比较4组患者的临床指标及助孕结局。结果4组患者在年龄、不孕类型/不孕年限、体质量指数(BMI)、基础性激素(FSH、LH、E_(2))水平及AMH水平方面比较均无统计学差异(P>0.05)。拮抗剂方案组卵泡均一性(≥18 mm卵泡/≥14 mm卵泡比例)显著低于其他3组(P<0.05),HCG日LH、P水平显著高于其他3组(P<0.05),获卵总数显著低于卵泡期长方案组(P<0.05),但其Gn用药天数以及用药剂量显著少于其他3组(P<0.05)。改良超长方案组HCG日E_(2)水平、获卵总数显著低于长效长方案和拮抗剂方案(P<0.05),卵泡期长方案的HCG日E_(2)也显著低于长效长方案组(P<0.05)。4组患者在2PN受精率、可移植胚胎数及优质胚胎数方面比较均无统计学差异(P>0.05)。改良超长方案组全胚冷冻率显著低于长效长方案组(P<0.05);鲜胚移植周期中改良超长方案及卵泡期长方案组临床妊娠率略高于长效长方案及拮抗剂方案,但4组患者间胚胎着床率、HCG阳性率、临床妊娠率及早期流产率方面比较均无统计学差异(P>0.05)。结论PCOS患者采用不同促排卵方案各有优劣,均能达成较好的临床结局;改良超长方案和卵泡期长方案临床妊娠率趋高,而拮抗剂方案具有Gn用药量较少和用药时间短的优点。Objective:To analyze the characteristics and outcomes of different controlled ovarian stimulation(COS)protocols in women with polycystic ovary syndrome(PCOS)who received IVF/ICSI-ET treatment.Methods:The clinical data of the PCOS patients(442 cycles)who underwent IVF/ICSI treatment in our hospital from January 2018 to October 2021 were retrospectively analyzed.According to the different COS protocols,the patients were divided into four groups:GnRH-agonist long protocol group(174 cycles),GnRH-agonist long protocol during follicular phase group(113 cycles),modified ultra-long protocol group(59 cycles)and GnRH antagonist protocol group(96 cycles).The clinical parameters and the pregnant outcomes in the four groups were compared.Results:There were no significant differences in the age,infertility type,infertility duration,body mass index(BMI),basal hormone levels(FSH,LH,E_(2))and AMH levels among the four groups(P>0.05).Comparing with the other three groups,the GnRH-antagonist protocol group had the least uniformity of follicles(ratio of≥18 mm follicles/≥14 mm follicles)and the highest LH and progesterone level on HCG trigger day(P<0.05),and the number of retrieval oocytes was significantly less than that in GnRH-agonist long protocol during follicular phase group(P<0.05).However,the days and dosage of gonadotropin(Gn)of the GnRH-antagonist protocol group were significantly less than those of the other three groups(P<0.05).Comparing with the GnRH-agonist long protocol group and GnRH-antagonist protocol group,the modified ultra-long protocol had significantly lower E_(2)level on HCG trigger day and significantly less oocytes retrieved(P<0.05).The E_(2)level on HCG trigger day in the GnRH-agonist long protocol during follicular phase group was also significantly lower than that in the GnRH-agonist long protocol group(P<0.05).There were no significant differences in the 2PN fertilization rate,the number of embryos transferred and the number of high-quality embryos among the four groups(P>0.05).The whole embryo freez

关 键 词：多囊卵巢综合征 体外受精-胚胎移植 控制性促排卵 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]