| 261 | 7 | 37 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨拮抗剂方案和长方案对超重多囊卵巢综合征(PCOS)患者助孕结局的影响。方法回顾性分析2013年1月1日至2017年11月30日于本生殖中心初次行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的PCOS且超重(BMI≥24 kg/m2)的356例患者临床资料,根据促排卵方案不同分为拮抗剂方案组(n=226)和长方案组(n=130),比较两组患者的基本资料、促排卵情况和临床结局,分析两组患者的中重度卵巢过度刺激综合征(OHSS)发生率、优质胚胎率、一次移植妊娠结局和累积活产率的差异。结果基本资料中,两组患者的女方年龄、BMI、基础睾酮水平差异均无统计学意义(P>0.05);与长方案组比较,拮抗剂方案组患者的基础FSH水平[(6.42±1.63)U/L vs.(6.78±1.53)U/L]显著降低(P<0.05),而窦卵泡数[(32.55±11.06)个vs.(28.02±7.09)个]显著增多(P<0.05)。促排卵情况比较中,拮抗剂方案组患者的扳机日LH和P水平以及优质胚胎率(38.04%vs. 32.26%)显著高于长方案组患者(P<0.05),但E2水平及获卵数无显著性差异(P>0.05)。在临床结局比较中,两种方案的中重度OHSS发生率、因OHSS高风险取消移植周期率、一次移植妊娠结局、乐观累积活产率以及保守累积活产率差异均无统计学意义。结论对于超重PCOS患者,与长方案相比,拮抗剂方案可获得更多的优质胚胎,但两种方案的临床结局相当。
Abstract：Objective:To explore the impact of clinical outcome between GnRH antagonist(GnRH-ant) protocol and long protocol among the overweight patients with polycystic ovarian syndrome(PCOS).Methods:The data of 356 overweight(BMI≥24 kg/m2)patients diagnosed as PCOS who underwent IVF/ICSI for the first time in our reproduction center from January 1,2013 to November 30,2017 were retrospectively analyzed. According to different ovulation induction protocols,the patients were divided into GnRH antagonist(GnRH-ant) protocol group(n=226) and long protocol group(n=130). The general characteristic,status of control ovarian hyperstimulation(COH) process and clinical outcome,incidence of middle to sever OHSS rate,high-quality embryos rate,pregnancy outcome of once transferred,and cumulative live birth rate were analyzed and compared between the two groups.Results:In general characteristic,there were no significant differences in age,BMI,and basal testosterone level between two groups. The patients with GnRH-ant had significantly lower basal FSH levels [(6.42±1.63)IU/L vs.(6.78±1.53)U/L] and higher antral follicles count(AFC) [(32.55±11.06) vs.(28.02±7.09)] compared the patients with long protocol. In COH process,the LH and progesterone levels on trigger day and high-quality embryos rate(38.04% vs. 32.26%) in GnRH-ant patients were significantly higher(P<0.05),but there was no significantly difference in estradiol level and number of oocytes retrieved between the two groups(P>0.05). In clinical outcome,there were significantly difference in incidence of middle to severe OHSS and cancellation rate of fresh cycles due to high OHSS risk,the optimistic cumulative live birth rate and the conservative cumulative live birth rate between two protocols(P>0.05).Conclusions:For overweight PCOS patients,GnRH antagonist protocol can obtain more high-quality embryos,but the clinical outcomes of the two protocols were similar.
[1] Norman RJ,Dewailly D,Legro RS,et al.Polycystic ovary syndrome[J].Lancet,2007,370:685-697.
[2] Chen X,Ni R,Mo Y,et al.Appropriate BMI levels for PCOS patients in Southern China[J].Hum Reprod,2010,25:1295-1302.
[3] Miro K,Slavko O,Ermin C,et al.The role of female obesity on in vitro fertilization outcomes[J].Gynecol Endocrinol,2018,34:184-188.
[4] Xu B,Chen Y,Geerts D,et al.Cumulative live birth rates in more than 3,000 patients with poor ovarian response:a 15 year survey of final in vitro fertilization outcome[J].Fertil Steril,2018,109:1051-1059.
[5] Kudesia R,Wu H,Cohn HK,et al.The effect of female body mass index on in vitro fertilization cycle outcomes:a multi-center analysis[J].J Assist Reprod Genet,2018,35:2013-2023.
[6] Schliep KC,Mumford SL,Ahrens KA,et al.Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization[J].Fertil Steril,2015,103:388-395.
[7] Cui N,Wang H,Wang W,et al.Impact of body mass index on outcomes of in vitro fertilization/intracytoplasmic sperm injection among polycystic ovarian syndrome patients[J].Cell Physiol Biochem,2016,39:1723-1734.
[8] Provost MP,Acharya KS,Acharya CR,et al.Pregnancy outcomes decline with increasing body mass index:analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008-2010 Society for Assisted Reproductive Technology registry[J].Fertil Steril,2016,105:663-669.
[9] 程兰兰,冯宗刚,万利静,等.体重指数对多囊卵巢综合征患者IVF/ICSI-ET助孕结局的影响[J].中国实用妇科与产科杂志,2018,34:425-428.
[10] Bu Z,Dai W,Guo Y,et al.Overweight and obesity adversely affect outcomes of assisted reproductive technologies in polycystic ovary syndrome patients[J].Int J Clin Exp Med,2013,6:991-995.
[11] 山惠枝,沈晓月,蒋玥,等.体重指数对PCOS患者IVF/ICSI治疗的影响[J].生殖医学杂志,2019,28:629-635.
[12] Healy M,Patounakis G,Zanelotti A,et al.Does premature elevated progesterone on the day of trigger increase spontaneous abortion rates in fresh and subsequent frozen embryo transfers?[J].Gynecol Endocrinol,2017,33:472-475.
[13] Requena A,Cruz M,Bosch E,et al.High progesterone levels in women with high ovarian response do not affect clinical outcomes:a retrospective cohort study[J].Reprod Biol Endocrinol,2014,12:69.
[14] Toftager M,Bogstad J,L?ssl K,et al.Cumulative live birth rates after one ART cycle including all subsequent frozen-thaw cycles in 1050 women:secondary outcome of an RCT comparing GnRH-antagonist and GnRH-agonist protocols[J].Hum Reprod,2017,32:556-567.
[15] Lambalk CB,Banga FR,Huirne JA,et al.GnRH antagonist versus long agonist protocols in IVF:a systematic review and meta-analysis accounting for patient type[J].Hum Reprod Update,2017,23:560-579.
[16] Zhao C,Liu X,Shi Z,et al.Role of serum miRNAs in the prediction of ovarian hyperstimulation syndrome in polycystic ovarian syndrome patients[J].Cell Physiol Biochem,2015,35:1086-1094.
[17] Yang W,Yang R,Lin M,et al.Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome[J].Reprod Biol Endocrinol,2018,16:119.
[18] De Vos M,Pareyn S,Drakopoulos P,et al.Cumulative live birth rates after IVF in patients with polycystic ovaries:phenotype matters[J/OL].Reprod Biomed Online,2018,37:163-171.
基本信息:
中图分类号:R714.8;R711.75
引用信息:
[1]范琪,林海燕,蓝洁,等.两种促排卵方案在超重多囊卵巢综合征患者中助孕效果的比较[J].生殖医学杂志,2021,30(02):139-144.
基金信息:
中山大学临床医学研究5010计划项目(2016004)
2020-05-24
2020
2020-10-20
2021-01-03
2021
1
2021-02-15
2021-02-15