PCOS患者促排卵过程中发生卵巢慢反应的影响因素分析

汤文娟，刘雨生，黄玲莉

(安徽医科大学附属省立医院生殖医学中心，合肥　230001)

PCOS患者促排卵过程中发生卵巢慢反应的影响因素分析

汤文娟，刘雨生*，黄玲莉

(安徽医科大学附属省立医院生殖医学中心，合肥230001)

【摘要】目的分析控制性超促排卵过程中多囊卵巢综合征(PCOS)不育症患者发生卵巢慢反应的临床指标，以指导其降调节及促性腺激素(Gn)启动剂量的调整。方法回顾性分析2011年1月至2015年4月，在我院生殖中心首次行体外受精-胚胎移植(IVF-ET)长方案助孕治疗的PCOS患者的临床资料，其中卵巢慢反应的57例患者为A组，114例卵巢反应正常的患者为B组。根据降调药物的不同将A组分为长效GnRH-a组(A1组)和短效GnRH-a组(A2组)。结果(1)A组的体重和体重指数(BMI)显著高于B组，A组的起始Gn剂量[(125.73±27.49)U]和起始每公斤体重Gn剂量[(1.99±0.43)U/kg]显著小于B组[分别为(135.41±29.42)U、(2.38±0.54)U/kg](P均<0.05)；(2)多因素Logistic回归分析显示体重是PCOS卵巢慢反应的独立危险因素(P<0.01)，起始每公斤体重Gn剂量是卵巢慢反应的独立保护因素(P<0.01)。(3)A1组和A2组相比启动日黄体生成素(LH)水平有降低趋势，但无显著性差异(P=0.073)，A1组起始每公斤体重Gn剂量[(2.19±0.39)U/kg]显著高于A2组[(1.92±0.43)U/kg](P<0.05)。结论体重过大、低起始Gn剂量是PCOS患者发生卵巢慢反应的主要影响因素。长效GnRH-a可能较短效GnRH-a更容易导致PCOS患者发生卵巢慢反应。

【关键词】体外受精-胚胎移植；卵胞浆内单精子注射；多囊卵巢综合征；控制性超促排卵；卵巢慢反应

Objective： To investigate influencing factors of slow response in patients with polycystic ovary syndrome (PCOS) for guiding down-regulation protocol and adjusting starting dose of gonadotropin (Gn).

Methods： The data of the PCOS patients undergone IVF-ET with the long protocol in our hospital from January 2011 to April 2015 were retrospectively analyzed. The patients were divided to two groups：57 patients with slow response in group A and 114 patients with normal response in group B. According to the type of GnRH agonist (GnRH-a) used，group A was subdivided into long-acting GnRH-a group (group A1) and short-acting GnRH-a group (group A2).

Results： The body weight and BMI of the patients in group A were significantly higher than those in group B. The starting Gn dose [(125.73±27.49) vs. (135.41±29.42) U] and starting Gn dose per kilogram of body weight [(1.99±0.43) vs. (2.38±0.54) U/kg] were significantly lower than those in group B (P<0.05). Multivariate logistic regression analysis showed that body weight was an independent risk factor for PCOS slow response (P<0.01)，and Gn starting dose per kilogram of body weight was an independent protective factor for PCOS slow response (P<0.01). LH levels on the starting day had a decreasing trend in group A1 but not significant (P=0.073)，and starting Gn dose per kilogram of body weight [(2.19±0.39) vs. (1.92±0.43) U/kg] in group A1 was significantly higher than that in group A2 (P<0.05).

Conclusions： Overweight and low starting Gn dose are the major factors affecting the slow response of PCOS patients. Long-acting GnRH-a is more likely to lead to slower response than short-acting GnRH-a in PCOS patients.

Key words： IVF-ET；ICSI；Polycystic ovary syndrome；Controlled ovarian hyperstimulation；Slow response

(J Reprod Med 2016，25(5)：395-400)

近年来，有研究认为在使用促性腺激素释放激素激动剂(GnRH-a)降调节长方案进行控制性超促排卵(COH)时，由于黄体生成素(LH)绝对或相对不足可能导致卵巢发生“慢反应”[1]，表现为一定剂量的卵泡刺激素(FSH)治疗初期，卵泡募集及激素水平正常[10个卵泡直径≥6 mm并且雌二醇(E2)≥366 pmol/L]，之后给予相同剂量的FSH，卵泡大小及血清雌二醇(E2)水平无明显增长，卵泡发育处于平台期，E2水平上升缓慢[2]。

多囊卵巢综合征(PCOS)患者被归类为对促性腺激素(Gn)高反应人群，因此，助孕治疗时常通过减小Gn启动剂量来防控卵巢过度刺激综合征(OHSS)的发生。……