摘要
目的 比较多囊卵巢综合征（PCOS）不孕患者卵泡早期行促性腺激素释放激素激动剂（GnRH-a）降调节后,行未成熟卵体外培养（IVM）和体外受精（IVF）的治疗结局.方法 对2010年7月至2012年12月,在温州医科大学附属第一医院生殖医学中心行辅助生殖治疗的72例PCOS不孕患者的临床资料进行回顾性分析.在卵泡早期使用GnRH-a降调节后,再根据治疗方法不同分为IVM组36例和IVF组36例,比较两组实验室指标及临床结局.结果 （1）实验室指标：IVM组共获卵442个,IVF组共获卵560个.IVF组的卵母细胞成熟率为83.8％ （469/560）,优质胚胎率为70.9％ （212/299）,均高于IVM组的54.1％（239/442）和50.7％（73/144）,分别比较,差异均有统计学意义（P ＜0.01）;IVM组促性腺激素（Gn）使用时间为（2.8±1.5）d,Gn用量为（285±169）U;IVF组Gn使用时间为（11.0±1.0）d,Gn用量为（1499±165）U,分别比较,差异也有统计学意义（P＜0.01）;IVM组的平均获卵数为（12.8±2.5）个、受精率为64.8％（155/239）、种植率为31％（23/74）,IVF组分别为（15.6±3.1）个、65.5％（307/469）、31％（23/74）,两组分别比较,差异均无统计学意义（P＞0.05）.（2）临床结局：IVM组的临床妊娠率为44％（14/32）,IVF组的临床妊娠率为55％（17/31）,两组比较,差异无统计学意义（P＞0.05）.IVF组的流产率为1/17,低于IVM组的1/14,但差异无统计学意义（P＞0.05）.IVM组无一例卵巢过度刺激综合征（OHSS）发生,IVF组中重度OHSS发生率为31％ （11/36）.结论 PCOS不孕患者卵泡早期GnRH-a降调节后行IVM和IVF治疗,均可获得比较满意的实验室和临床结局.IVM组的治疗周期短且可完全避免OHSS的发生,但流产率有升高趋势.IVF组的OHSS发生率较高,且促排卵药物用量增多.
Objective To compare the outcomes of in-vitro maturation （IVM） and in-vitro fertilization （IVF） after early follicular phase gonadotropin-releasing hormone agonist （GnRH-a）down-regulation in infertile patients with polycystic ovary syndrome （PCOS）.Methods From July 2010 to December 2012,72 infertile patients with PCOS undergoing assisted reproductive technology treatment in the Affiliated First Hospital of Wenzhou Medical University were enrolled in this study.The patients were divided into 2 groups,which were patients with early follieular phase down-regulation IVM （36 cases） at IVM group and early follicular phase down-regulation long protocol IVF （36 cases） at IVF group.The laboratory parameters and clinical outcomes were compared between two groups.Results （1） Lab parameters：a total of 442 oocytes were retrieved in group IVM,and 560 were in group IVF.The rate of mature oocytes of 83.8％ （469/560） and high-quality embryos of 70.9％ （212/299） at group IVF were significantly higher than that of group IVM [54.1％ （239/442） and 50.7％ （73/144）,retrospectively,P ＜0.01].In group IVM,the average duration of gonadotropin （Gn） was （2.8 ± 1.5） days and the average dosage of Gn was （285 ± 169） U,which were significantly lower than （11.0 ± 1.0） days and （1499 ±165） U in group IVF （P ＜0.01）.The mean number of oocytes retrieved 12.8 ± 2.5,fertilization rate of 64.8％ （155/239）,and implantation rate of 31％ （23/74） in group IVM and 15.6 ±3.1,65.5％ （307/469）,31％ （23/74） in group IVF,which did not reach statistical difference （P ＞0.05）.（2） Clinical outcomes：the clinical pregnancy rate （17/31,55％） of IVF group was not significantly higher than that 44％ （14/32） at IVM group （P ＞ 0.05）.The abortion rate was 1/17 at Group IVF and 1/14 in group IVM,which did not show statistical difference.Women at IVM group has no ovarian hyper-stimulation syndrome （OHSS） cycle,group IVF has 31％ （11/36） cycles presented moderate and severe OHSS.Conclusions Infertile patients with PCOS undergoing IVM and IVF treatment after early follicular phase GnRH-a down-regulation can get satisfactory laboratory and clinical outcome.In addition to short treatment cycle,IVM can also avoid the occurrence of OHSS completely,but it has a rising trend in the abortion rate.IVF has a high incidence of OHSS,meanwhile,it increases the dosage of gonadotropins.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2013年第11期833-837,共5页
Chinese Journal of Obstetrics and Gynecology
基金
温州市科技局项目（Y20090235）
