生殖医学杂志

目的 探讨多囊卵巢综合征(PCOS)高雄型患者与非高雄型患者行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕妊娠结局的差异。方法 回顾性分析2019年1月至2023年12月于邢台不孕不育专科医院行IVF/ICSI-ET治疗的298例PCOS患者的临床资料(共298个周期),根据患者助孕前雄激素水平是否升高及有无高雄激素临床表现分为高雄组(150个周期)和非高雄组(148个周期)。比较两组患者的基础资料、促排卵情况、胚胎实验室参数及妊娠结局，采用二元Logistic回归分析高雄激素等因素对妊娠结局的影响。结果 高雄组中黄体生成素与卵泡刺激素比值(LH/FSH)≥2的患者比例显著高于非高雄组，雌二醇(E₂)、睾酮(T)、抗苗勒管激素(AMH)、总胆固醇(TC)水平显著高于非高雄组，FSH、高密度脂蛋白胆固醇(HDL-C)水平显著低于非高雄组(P均<0.05)。高雄组中行IVF+补救ICSI(R-ICSI)的患者比例显著高于非高雄组(P<0.05);两组间促性腺激素(Gn)总量、Gn天数、可用胚胎率、优质胚胎率、囊胚形成率、胚胎移植时间、移植胚胎数、移植日内膜厚度比较均无显著性差异(P>0.05)。高雄组的胚胎种植率(45.65%vs. 55.31%)、活产率(45.33%vs. 60.14%)显著低于非高雄组，早期流产率(26.88%vs. 15.24%)显著高于非高雄组(P均<0.05);两组间临床妊娠率、多胎率、剖宫产率、低体重儿出生率比较均无显著性差异(P>0.05)。二元Logistic回归分析显示：T水平升高、LH/FSH比值增加、TC水平升高和HDL-C水平降低为PCOS患者胚胎种植失败的危险因素(P<0.05)。结论 PCOS高雄型患者IVF/ICSI-ET助孕治疗后的胚胎种植率和活产率显著降低，早期流产风险显著增加，且血脂代谢异常可能进一步加剧胚胎种植失败风险。

Objectives:To investigate the differences on pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) among patients with polycystic ovary syndrome(PCOS) with hyperandrogenism(HA) and non-HA.Methods:The clinical data of 298 PCOS patients(298 cycles in total) treated with IVF/ICSI-ET in Xingtai Infertility Specialist Hospital from January 2019 to December 2023 were retrospectively analyzed. According to whether the androgen level increased before pregnancy assistance or whether there were hyperandrogenic clinical manifestations, the patients were divided into HA group(150 cycles) and non-HA group(148 cycles). The basic data, ovulation induction, embryo laboratory parameters and pregnancy outcomes of the two groups were compared, and the effects of HA and other factors on pregnancy outcomes were analyzed by the binary logistic regression.Results:The ratio of luteinizing hormone to follicle stimulating hormone(LH/FSH) ≥2 in HA group was significantly higher than that in non-HA group, and the levels of estradiol(E₂),testosterone(T),anti-Müllerian hormone(AMH) and total cholesterol(TC) were significantly higher than those in non-HA group, while the levels of follicle-stimulating hormone(FSH) and high-density lipoprotein cholesterol(HDL-C) were significantly lower than those in non-HA group(P<0.05). The proportion of patients undergoing IVF+ rescue-ICSI(R-ICSI) in the HA group was significantly higher than that in the non-HA group(P<0.05). There were no significant differences in total gonadotropin(Gn),duration of Gn use, usable embryo rate, high-quality embryo rate, blastocyst formation rate, transfer time, number of transferred embryos, and endometrial thickness on transfer day between the two groups(P>0.05). The embryo implantation rate(45.65% vs. 55.31%) and the live birth rate(45.33% vs. 60.14%) in the HA group were significantly lower than those in the non-HA group, and the early abortion rate(26.88% vs. 15.24%) was significantly higher than that in the non-HA group(P<0.05). There were no significant differences in clinical pregnancy rate, the rate of multiple births, cesarean section rate and low birth weight rate between the two groups(P>0.05). The binary logistic regression analysis showed that the increase of T level, the increase of LH/FSH ratio, the increase of TC level and the decrease of HDL-C level were the risk factors of embryo implantation failure in PCOS patients(P<0.05).Conclusions:HA significantly reduces the embryo implantation rate and the live birth rate of PCOS patients treated with IVF/ICSI-ET,and increases the risk of early abortion. Abnormal blood lipid metabolism may further aggravate the risk of embryo implantation failure.