溫和刺激方案在多囊卵巢綜合征患者體外受精—胚胎移植中的應用研究

李霞　彭璇　段娟

[摘要] 目的 探討溫和刺激方案在多囊卵巢綜合征（PCOS）患者體外受精-胚胎移植周期中的臨床應用。 方法 選取2015年3月～2017年6月在我院接受體外受精-胚胎移植（IVF-ET）的PCOS患者共80例，將患者隨機分為克羅米芬溫和刺激方案（A組）40例和短效促性腺激素釋放激素激動劑（GnRHa）長方案（B組）40例，比較兩組患者IVF周期的一般情況、促排卵參數、實驗室指標及解凍胚胎移植（FET）臨床妊娠率。 結果 ①兩組患者年齡、不孕年限、基礎FSH、基礎 LH、基礎 E2、體質量指數（BMI）均無統計學差異（P>0.05）；②A組使用促性腺激素（Gn）天數和Gn用量顯著低于B組（P<0.05）；③兩組注射人絨毛膜促性腺激素（HCG）日E2、P無顯著性差異（P>0.05）；而HCG日LH水平A組顯著高于B組，差異有統計學意義（P<0.01）；④兩組獲卵數、卵裂率、優質胚胎率差異均無統計學意義（P>0.05），而A組正常受精率、冷凍胚胎數低于B組，差異有統計學意義（P<0.05）；⑤A組中度卵巢過度刺激綜合征（OHSS）率明顯低于B組，但差異無統計學意義（P>0.05）；⑥A組FET臨床妊娠率高于B組，但差異無統計學意義（P>0.05）。 結論 克羅米芬溫和刺激方案在PCOS患者IVF-ET治療中有較理想的促排效果，可明顯減少Gn天數及Gn總量，從而減少患者周期治療費用；OHSS并發癥發生率較低，且能獲得理想的臨床妊娠率。

[關鍵詞] 多囊卵巢綜合征；溫和刺激方案；促性腺激素釋放激素激動劑；體外受精-胚胎移植；胚胎解凍移植

[中圖分類號] R714.8 [文獻標識碼] B [文章編號] 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

多囊卵巢綜合征（polycystic ovary syndrome，PCOS）是一種常見的婦科內分泌疾病，發生率占育齡婦女的5%～10%。常見的臨床表現為月經稀發或閉經，排卵異常或不孕，高雄激素血癥或高雄臨床表現，如多毛、痤瘡等。一部分患者需要借助試管嬰兒（in vitro fertilization and embryo transfer，IVF-ET）解決生育問題。本研究通過比較PCOS患者溫和刺激方案與常規長方案的臨床效果，旨在探討一個更加安全、經濟、高效的促排卵方案。