复方口服避孕药预处理后促排卵过程中PCOS患者发生薄型内膜的相关因素分析  

Analysis of influencing factors of thin endometrium during controlled ovarian stimulation after pretreatment with compound oral contraceptive in PCOS patients

作　　者：张岚 余红 李玉立 殷菲 陈杰 詹超武 ZHANG Lan;YU Hong;LI Yu-li;YIN Fei;CHEN Jie;ZHAN Chao-wu(Department of Reproductive Medicine,the Second People’s Hospital of Wuhu,Wuhu241000)

机构地区：[1]芜湖市第二人民医院生殖医学科,芜湖241000

出　　处：《生殖医学杂志》2023年第4期542-548,共7页Journal of Reproductive Medicine

基　　金：芜湖市科技计划项目(2020ms3-13)。

摘　　要：目的探讨性激素水平异常的多囊卵巢综合征(PCOS)患者使用复方口服避孕药(COC)预处理后促排卵治疗时发生薄型内膜的影响因素及其对妊娠结局的影响。方法选取2019年6月至2021年12月在我院就诊的性激素水平异常的69例PCOS患者(共162个促排卵周期)为研究对象,进行COC预处理,待激素水平降至正常后给予促排卵治疗;并根据促排卵周期中卵泡直径>18 mm时或HCG注射日内膜厚度不同进行分组:薄型内膜组(内膜厚度<7 mm)29个周期和正常内膜组(内膜厚度>7 mm)133个周期。比较两组患者的一般资料、促排卵结局及妊娠结局。结果162个促排卵周期中,29个周期出现薄型内膜,发生率为17.90%。薄型内膜组与正常内膜组的年龄、体质量指数(BMI)及COC时长比较均无显著性差异(P>0.05),薄型内膜组的抗苗勒管激素(AMH)水平、停COC时长、尿促性素(HMG)用量、HMG使用率及促排卵前一周期孕酮使用率均显著低于正常内膜组(P<0.05);两组患者COC使用前后的卵泡刺激素(FSH)、黄体生成素(LH)及睾酮(T)水平均无显著性差异(P>0.05)。多因素Logistic回归分析发现,促排卵前一周期是否使用孕酮及促排卵周期中HMG用量大小是薄型内膜发生的显著影响因素(P<0.05)。薄型内膜组与正常内膜组的胚胎着床率、临床妊娠率、妊娠丢失率及活产率均无显著性差异(P>0.05);促排卵前一周期使用孕酮的患者的着床率、临床妊娠率及活产率均显著高于未用孕酮患者(P<0.05)。结论对于COC预处理后拟行促排卵治疗的PCOS患者,停用COC后先给予孕激素转化内膜再促排卵,以及适当使用促性腺激素联合促排卵,可以减少薄型内膜发生并提高内膜容受性,改善妊娠结局。Objective:To investigate the influencing factors of thin endometrium during controlled ovarian stimulation(COS)after pretreatment with compound oral contraceptive(COC)and pregnancy outcome in patients with polycystic ovary syndrome(PCOS)and abnormal sex hormone levels.Methods:Sixty-nine PCOS patients with abnormal sex hormone levels(162 COS cycles)were selected as the subjects for COC pretreatment in our hospital from June 2019 to December 2021,and COS treatment was given after the hormone level dropped to normal.According to the thickness of endometrium when the follicular diameter>18 mm or on the day of HCG injection during COS,the patients were divided into thin endometrium group(endometrial thickness<7 mm,29 cycles)and normal endometrium group(endometrial thickness>7 mm,133 cycles).The general information,COS outcome and pregnancy outcome of the two groups were compared.Results:In 162 cycles of COS,thin endometrium appeared in 29 cycles(17.90%).There were no significant differences in age,body mass index(BMI)and duration of COC between the thin endometrium group and the normal endometrium group(P>0.05).The level of anti-Mullerian hormone(AMH),the duration of COC cessation,the dosage of gonadotropin(HMG)used,the HMG use rate and progesterone use rate in the previous menstrual cycle before COS were significantly lower in the thin endometrium group than those in the normal endometrium group(P<0.05).There were no significant differences in the levels of FSH,LH and testosterone(T)before and after COC treatment between the two groups(P>0.05).Multivariate Logistic regression analysis showed that whether progesterone was used in the previous cycle before COS and the amount of HMG used in COS cycles were the significant factors affecting the occurrence of thin endometrium(P<0.05).There were no significant differences in implantation rate,clinical pregnancy rate,pregnancy loss rate and live birth rate between thin endometrium group and normal endometrium group(P>0.05).The implantation rate,clinical pregnancy rate and l

关 键 词：多囊卵巢综合征 复方口服避孕药 薄型子宫内膜 

分 类 号：R711.75[医药卫生—妇产科学]