温和刺激方案在多囊卵巢综合征患者体外受精—胚胎移植中的应用研究

李霞　彭璇　段娟

[摘要] 目的 探討温和刺激方案在多囊卵巢综合征（PCOS）患者体外受精-胚胎移植周期中的临床应用。 方法 选取2015年3月～2017年6月在我院接受体外受精-胚胎移植（IVF-ET）的PCOS患者共80例，将患者随机分为克罗米芬温和刺激方案（A组）40例和短效促性腺激素释放激素激动剂（GnRHa）长方案（B组）40例，比较两组患者IVF周期的一般情况、促排卵参数、实验室指标及解冻胚胎移植（FET）临床妊娠率。 结果 ①两组患者年龄、不孕年限、基础FSH、基础 LH、基础 E2、体质量指数（BMI）均无统计学差异（P>0.05）；②A组使用促性腺激素（Gn）天数和Gn用量显著低于B组（P<0.05）；③两组注射人绒毛膜促性腺激素（HCG）日E2、P无显著性差异（P>0.05）；而HCG日LH水平A组显著高于B组，差异有统计学意义（P<0.01）；④两组获卵数、卵裂率、优质胚胎率差异均无统计学意义（P>0.05），而A组正常受精率、冷冻胚胎数低于B组，差异有统计学意义（P<0.05）；⑤A组中度卵巢过度刺激综合征（OHSS）率明显低于B组，但差异无统计学意义（P>0.05）；⑥A组FET临床妊娠率高于B组，但差异无统计学意义（P>0.05）。 结论 克罗米芬温和刺激方案在PCOS患者IVF-ET治疗中有较理想的促排效果，可明显减少Gn天数及Gn总量，从而减少患者周期治疗费用；OHSS并发症发生率较低，且能获得理想的临床妊娠率。

[关键词] 多囊卵巢综合征；温和刺激方案；促性腺激素释放激素激动剂；体外受精-胚胎移植；胚胎解冻移植

[中图分类号] R714.8 [文献标识码] B [文章编号] 1673-9701（2017）36-0090-04

[Abstract] Objective To investigate the clinical application of mild stimulation regimen in the in vitro fertilization-embryo transfer of patients with polycystic ovary syndrome（PCOS）. Methods A total of 80 PCOS patients undergoing in vitro fertilization-embryo transfer（IVF-ET） in our hospital from March 2015 to June 2017 were randomly divided into group A（n=40） with clomiphene mild stimulation program and group B（n=40） with long program of short-acting gonadotropin-releasing hormone agonist. The general situation of IVF cycles， ovulation induction parameters， laboratory indicators and clinical pregnancy rate of frozen-thawed embryo transfer（FET） between the two groups were compared. Results ①There were no significant differences in age， duration of infertility， basal FSH， basal LH， basal E2， body mass index（BMI） between the two groups（P>0.05）. ②The days of gonadotropin（Gn） and the amount of Gn in the group A were significantly less than those in the group B（P<0.05）.③There were no significant differences in the E2 and P between the two groups on the day of injecting human chorionic gonadotropin（HCG）（P>0.05）. While the level of LH on the day of HCG in group A was significantly higher than that in group B， and the difference was statistically significant（P<0.01）. ④There were no significant differences in the number of gaining oocytes， cleavage rate and high-quality embryos between the two groups（P>0.05）， while the normal fertilization rate and the number of frozen embryos in group A were lower than those in group B， and the difference was statistically significant（P<0.05）. ⑤Moderate ovarian hyperstimulation syndrome（OHSS） ratein group A was lower than that in group B， but the difference was not statistically significant（P>0.05）. ⑥FET clinical pregnancy rate in the group A was higher than that in the group B， without statistically significant difference（P>0.05）. Conclusion Clomiphene mild stimulation regimen in the PCOS IVF-ET treatment of patients has an ideal effect of promoting the ovulation induction， which can significantly reduce the Gn days and the total Gn， thereby reducing the cost of cycle treatment of patients， with low OHSS complication rate， and can gain the ideal clinical pregnancy rate.

[Key words] Polycystic ovary syndrome； Mild stimulation regimen； Gonadotropin-releasing hormone agonist； In vitro fertilization and embryo transfer； Fronzen-thawed embryo transfer

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是一种常见的妇科内分泌疾病，发生率占育龄妇女的5%～10%。常见的临床表现为月经稀发或闭经，排卵异常或不孕，高雄激素血症或高雄临床表现，如多毛、痤疮等。一部分患者需要借助试管婴儿（in vitro fertilization and embryo transfer，IVF-ET）解决生育问题。本研究通过比较PCOS患者温和刺激方案与常规长方案的临床效果，旨在探讨一个更加安全、经济、高效的促排卵方案。