摘要
目的研究高龄多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者在行体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)助孕促排卵过程的卵巢反应性及妊娠结局的影响。方法采用回顾性队列研究,选择2016年1月1日至2018年12月31日期间在北京大学第三医院生殖医学中心首次行IVF/ICSI助孕的201例高龄PCOS女性患者为PCOS组,按照1∶1匹配原则,选取在同时期进周期的、单纯因输卵管因素首次行IVF/ICSI助孕的高龄非PCOS月经规律的201例患者记为对照组。并选取此次取卵周期的前三个解冻周期,高龄PCOS患者因卵巢过度刺激综合征发生率更高,进行冷冻胚胎的人数更多,因此高龄PCOS患者解冻周期多于对照组患者。PCOS组共215个周期,对照组共124个周期,分析两组患者的临床资料和IVF实验室资料。结果①PCOS组与对照组相比,抗苗勒管激素(anti-Müllerian hormone,AMH)和窦卵泡计数(antral follicle count,AFC)差异均有统计学意义[(7.66±4.62)μg/L比(1.89±1.44)μg/L,P=0.005;26.44±8.06比9.33±4.05,P<0.001];PCOS组的优质胚胎率高于对照组[58.04%(1281/2207)比57.20%(743/1299),P=0.005]。②PCOS组促排卵过程中促性腺激素(gonadotropin,Gn)用量更少[(2090.17±909.74)U比(2969.14±1101.79)U,P=0.009]、获卵数更多[(15.17±8.35)枚比(9.51±5.83)枚,P<0.001];PCOS组的临床妊娠率、流产率、异位妊娠率、累积活产率与对照组相比差异均无统计学意义(均P>0.05)。③年龄、体质量指数(body mass index,BMI)、睾酮水平、促排卵方案及移植胚胎数为临床妊娠率的独立影响因素(P=0.028、P=0.004、P=0.027、P=0.014、P<0.001);BMI和移植胚胎数为活产率的独立影响因素(P=0.008、P<0.001)。结论①高龄PCOS患者有更高的卵泡储备量。②累积活产率更能真实地反映高龄PCOS患者生育窗情况,高龄PCOS患者累积活产率随着年龄的增长明显�
Objective To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome(PCOS).Methods A retrospective cohort study was conducted,and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1,2016 to December 31,2018 were selected as PCOS group.According to the 1∶1 matching principle,selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group.The first three thawing cycles of this egg retrieval cycle were selected.Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing,the thawing cycles of the elderly PCOS patients were more than those of control group.A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results 1)Between PCOS group and control group,anti-Müllerian hormone(AMH)and antral follicle count(AFC)were significantly different[(7.66±4.62)μg/L vs.(1.89±1.44)μg/L,P=0.005;26.44±8.06 vs.9.33±4.05,P<0.001];the rate of high-quality embryos in PCOS group was higher than that in control group[58.04%(1281/2207)vs.57.20%(743/1299),P=0.005].2)The dosage of gonadotropin(Gn)used during ovulation induction in PCOS group was less than that in control group[(2090.17±909.74)U vs.(2969.14±1101.79)U,P=0.009],but the number of oocytes retrieval was more than that in control group(15.17±8.35 vs.9.51±5.83,P<0.001).The clinical pregnancy rate,the miscarriage rate,the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group(all P>0.05).3)Age,body mass index(BMI
作者
倪潇潇
王颖
闫艺之
杨蕊
王琳琳
陈立雪
Xiaoxiao Ni;Ying Wang;Yizhi Yan;Rui Yang;Linlin Wang;Lixue Chen(Reproductive Medical Center,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10期1046-1057,共12页
Chinese Journal of Reproduction and Contraception
基金
国家自然科学基金(81550022,81873833)。
关键词
多囊卵巢综合征
生殖技术
辅助
受精
体外
胚胎移植
妊娠结局
高龄
Polycystic ovary syndrome
Reproductive technologies,assisted
Fertilization in vitro
Embryo transfer
Pregnancy outcome
Elderly
