摘要
目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕症患者自然周期获卵数的影响因素及其与体外成熟(in vitro maturation,IVM)结局的相关性。方法本研究采用队列研究方法,回顾2006年1月1日至2019年12月31日期间在北京大学第三医院妇产科生殖医学中心接受自然周期取卵的586例PCOS不孕症患者的临床资料,按照获卵数(0~8、9~19、≥20)将患者分为3组,比较组间患者的一般情况、激素水平、卵成熟和胚胎发育指标、移植周期临床妊娠和活产结局。结果获卵数为0~8组、9~19组和≥20组的患者黄体生成素(luteinizing hormone,LH)/卵泡刺激素(follicle-stimulating hormone,FSH)[1.00(0.61,1.76)、1.41(0.86,1.96)、1.62(0.96,2.14)]、睾酮水平[1.07(0.69,1.91)nmol/L、1.28(0.77,1.95)nmol/L、1.67(1.03,2.75)nmol/L]和窦卵泡计数(antral follicle count,AFC)[24(19,24)、24(24,30)、30(24,40)]组间比较差异均有统计学意义(均P<0.001)。多因素logistic回归结果显示AFC是影响获卵数的显著因素(P_(9~19/0~8)=0.002,P_(≥20/0~8)<0.001),LH/FSH是去除AFC后影响获卵数最显著的内源性因素(P_(9~19/0~8)=0.006,P_(≥20/0~8)=0.003)。通过倾向性评分匹配(propensity score matching,PSM)后显示,获卵数越多,每未成熟卵成熟率[0~8组:48.0%(242/504),9~19组:44.8%(539/1202),≥20组:40.4%(1067/2640),P=0.001]、正常受精率[0~8组:31.7%(160/504),9~19组:25.5%(306/1202),≥20组:23.7%(625/2640),P=0.001]和可移植胚胎率[0~8组:19.2%(97/504),9~19组:11.6%(140/1202),≥20组:6.0%(153/2540),P<0.001]则越低,可移植胚胎形成周期率[0~8组:51.1%(47/92),9~19组:66.3%(61/92),≥20组:73.9%(68/92),P=0.005]则越高。移植周期不同获卵数分组间的每新鲜移植周期和每冻融移植周期临床妊娠率及活产率、累积临床妊娠率和累积活产率差异均无统计学意义(均P>0.05)。结论AFC是预测PCOS患者自然周期获卵数的有效指标,同时LH/FSH也是影响获卵数显著的内源因素。随着获卵数
Objective To investigate the factors that influence the number of oocytes retrieved of patients with polycystic ovary syndrome(PCOS)undergoing unstimulated natural cycles and the association between the number of oocytes retrieved and in vitro maturation(IVM)outcomes.Methods This retrospective cohort study reviewed clinical data of 586 patients with PCOS undergoing unstimulated natural cycle at Reproductive Medicine Center,Department of Obstetrics and Gynecology of Peking University Third Hospital from 2006 January 1 to 2019 December 31.All patients were divided into three groups according to the number of oocytes retrieved(0-8,9-19,≥20).Basic information,basal endocrine hormones,oocyte and embryo development index and clinical outcomes were compared among the three groups.Results Luteinizing hormone(LH)/follicle-stimulating hormone(FSH)[1.00(0.61,1.76),1.41(0.86,1.96),1.62(0.96,2.14)],testosterone[1.07(0.69,1.91)nmol/L,1.28(0.77,1.95)nmol/L,1.67(1.03,2.75)nmol/L]and antral follicle count(AFC)[24(19,24),24(24,30),30(24,40)]were significantly different among 0-8 group,9-19 group and≥20 group(all P<0.001).Multivariate logistic regression analysis showed that AFC was a significant factor affecting the number of oocytes retrieved(P_(9-19/0-8)=0.002,P_(≥20/0-8)<0.001),and LH/FSH was an significant internal factor affecting the number of oocytes retrieved(P_(9-19/0-8)=0.006,P_(≥20/0-8)=0.003)after the removal of AFC.Results of the analysis in patients after propensity score matching(PSM)showed that the number of oocytes retrieved was negatively correlated with oocyte maturation rate[0-8 group:48.0%(242/504),9-19 group:44.8%(539/1202),≥20 group:40.4%(1067/2640),P=0.001],fertilization rate[0-8 group:31.7%(160/504),9-19 group:25.5%(306/1202),≥20 group∶23.7%(625/2640),P=0.001]and transferable embryo rate[0-8 group:19.2%(97/504),9-19 group:11.6%(140/1202),≥20 group:6.0%(153/2540),P<0.001],while positively correlated with transferable embryo formation cycle rate[0-8 group:51.1%(47/92),9-19 group:66.3%(61/92),
作者
刘涛
刘东明
宋雪凌
郑晓英
马彩虹
李蓉
严杰
乔杰
Liu Tao;Liu Dongming;Song Xueling;Zheng Xiaoying;Ma Caihong;Li Rong;Yan Jie;Qiao Jie(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2022年第8期782-790,共9页
Chinese Journal of Reproduction and Contraception
基金
国家重点研发项目(2018YFC1004001,2017YFC1002002,2019YFA0801400)
国家自然科学基金(81571386,81730038)
中国医学科学院卵成熟障碍综合诊治研究创新单元(2019-I2M-5-001)
首都卫生发展科研专项(2018-2-4095)。
关键词
多囊卵巢综合征
获卵数
自然周期
临床妊娠率
活产率
Polycystic ovary syndrome
Number of oocytes retrieved
Natural cycle
Clinical pregnancy rate
Live birth rate
