摘要
目的研究多囊卵巢综合征(PCOS)患者促性腺激素释放激素拮抗剂(GnRH-ant)方案控制性卵巢刺激(COS)过程中,雌二醇(E_(2))变化对助孕结局的影响。方法回顾性研究接受GnRH-ant方案超促排卵并进行体外受精(IVF)或单精子卵胞质内注射(ICSI)后,首次进行冻融胚胎移植(FET)的338例PCOS不孕症患者的临床资料。根据患者应用GnRH-ant第1天和第4天的血清E_(2)水平变化(均在注射GnRH-ant前留取血液样本)进行分组:E_(2)升高组(A组,E_(2)升高超过30%,165例),E_(2)持平组(B组,E_(2)在-30%~30%之间,162例),E_(2)下降组(E_(2)降低超过30%,11例,病例数少未进行统计学分析)。分析A、B两组患者的基本资料、促排卵情况、胚胎情况和临床妊娠相关指标的差异。结果A、B两组患者的年龄、不孕年限、体质量指数(BMI)水平、基础内分泌水平、抗缪勒管激素(AMH)水平等基本资料以及促排卵治疗时的各项数据差异均无统计学意义。在胚胎情况方面,A、B两组患者的受精方式及移植胚胎数差异无统计学意义,但A组患者的获卵总数、正常受精率、优质胚胎数、优胚率均高于B组患者,差异有统计学意义(P<0.05)。在临床妊娠情况方面,A、B两组患者的重度卵巢过度刺激综合征(OHSS)发生率差异无统计学意义,但A组患者的临床妊娠率、着床率、活产率均优于B组,差异有统计学意义,A组患者的早期流产率低于B组,差异有统计学意义。结论选择GnRH-ant方案进行IVF/ICSI-FET的PCOS患者,如果在添加拮抗剂4 d后血E_(2)水平(注射GnRH-ant前留取血液样本)升高>30%,其临床妊娠结局会更好。
Objective To study the effect of changes in estradiol(E_(2))levels on the reproductive outcomes of patients with polycystic ovary syndrome(PCOS)undergoing controlled ovarian stimulation(COS)with gonadotropin-releasing hormone antagonist(GnRH-ant)protocol.Methods A retrospective study was conducted involving 338 patients with polycystic ovary syndrome(PCOS)infertility who underwent GnRH-ant protocol for controlled ovarian hyperstimulation followed by in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI),and subsequently underwent their first frozen-thawed embryo transfer(FET).The clinical data of these patients were analyzed.Patients were grouped based on the changes in serum E_(2)levels on the first and fourth day of GnRH-ant administration(blood samples collected before GnRH-ant injection):the E_(2)elevation group(Group A,E_(2)value increased more than 30%,165 cases),the E_(2)stable group(Group B,E_(2)rate of change was within-30%~30%,162 cases),and the E_(2)decline group(E_(2)value declined more than 30%,11 cases,not included in statistical analysis due to small sample size).The differences in demographic characteristics,ovulation induction outcomes,embryo outcomes and clinical pregnancy-related indicators were analyzed between Groups A and B.Results There were no statistically significant differences in basic information such as age,duration of infertility,body mass index(BMI),basal endocrine levels,and anti-Müllerian hormone(AMH)levels between groups A and B.Regarding embryo characteristics,there were no statistically significant differences in fertilization method and number of transferred embryos between groups A and B.However,group A had a higher total number of retrieved oocytes,normal fertilization rate,number of high-quality embryos,and rate of high-quality embryos compared to group B,with statistically significant differences(P<0.05).In terms of clinical pregnancy outcomes,there were no statistically significant differences in the incidence of severe ovarian hyperstimulation syndrome(OHSS)between groups A and B.However,group A had higher rates of clinical pregnancy,implantation,and live birth compared to group B,with statistically significant differences.Group A also had a lower rate of early miscarriage compared to group B,with statistically significant differences.Conclusion Choosing the GnRH-ant protocol for IVF/ICSI-FET in PCOS patients,if the blood E_(2)level increases by more than 30%after 4 days of adding the antagonist(blood sample collected before administering GnRH-ant),the clinical pregnancy outcome will be better.
作者
刘莉
吴彩云
管凌芳
周平
Liu Li;Wu Caiyun;Guan Lingfang;Zhou Ping(Dept of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Hefei 230032;Dept of Obstetrics and Gynecology,Fuyang Affiliated Hospital of Anhui Medical University,Fuyang 236000;NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract,Anhui Medical University,Hefei 230032;Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs,Hefei 230032)
出处
《安徽医科大学学报》
CAS
北大核心
2024年第6期961-965,共5页
Acta Universitatis Medicinalis Anhui
基金
国家自然科学基金(编号:82301896)。
关键词
多囊卵巢综合征
拮抗剂方案
雌二醇
妊娠结局
polycystic ovary syndrome
antagonist protocol
estradiol
pregnancy outcome
