摘要
目的探讨高孕激素状态下促排卵方案(PPOS)、拮抗剂方案和超长方案对多囊卵巢综合征(PCOS)不孕症患者行IVF-ET中的临床效果。方法回顾性分析2019年1月至2022年3月在我院生殖医学中心以PPOS方案、拮抗剂方案和超长方案促排卵的PCOS不孕症患者资料,共390例。按照促排卵方案不同分为PPOS方案组(n=43)、拮抗剂方案组(n=177)和超长方案组(n=170),比较3组患者的一般资料、控制性促排卵(COS)过程参数、胚胎实验室参数和妊娠结局的差异。结果3组患者的一般资料比较均无显著性差异(P>0.05)。促排卵过程比较:与拮抗剂方案组相比,PPOS方案组和超长方案组的Gn总天数、Gn总用量均显著升高,HCG日LH、E_(2)及P水平均显著降低(P<0.05);PPOS方案组和超长方案组比较,HCG日LH和E_(2)水平显著升高(P<0.05),其余指标差异均无统计学意义(P>0.05)。胚胎实验室参数比较:PPOS方案组获卵数、OHSS发生率、累计妊娠率均显著低于拮抗剂方案组和超长方案组(P<0.05);PPOS方案组和拮抗剂方案组的卵母细胞利用率均显著高于超长方案组(P<0.05),而PPOS方案组与拮抗剂方案组差异无统计学意义(P>0.05);PPOS方案组卵裂率显著高于拮抗剂方案组和超长方案组(P<0.05)。妊娠结局比较:3组间流产率无显著差异(P>0.05);在新鲜胚胎移植周期中,超长方案组的持续妊娠率显著高于拮抗剂方案组(P<0.05),而在冷冻胚胎移植周期中,3组间的持续妊娠率无统计学差异(P>0.05)。结论对于PCOS患者,相比常规拮抗剂方案及超长方案,PPOS方案费用低廉,OHSS风险更低,获卵数和累计妊娠率虽显著低于拮抗剂方案和超长方案,但胚胎实验室数据和拮抗剂相当,有优于超长方案的趋势,且在冷冻胚胎移植周期能获得相似的持续妊娠率。由于本研究为回顾性研究,存在一定的局限性,仍需要前瞻性大型随机对照试验进一步观察验证本文结论。
Objective:To investigate the clinical effects of progestin-primed ovarian stimulation(PPOS)protocol,antagonist protocol,ultralong protocol on IVF-ET in infertile women with polycystic ovary syndrome(PCOS).Methods:The data of 390 infertile PCOS patients undergone the first IVF-ET treatment in our hospital from January 2019 to March 2022 were retrospectively analyzed.According to different controlled ovarian stimulation(COS)protocols,the patients were divided into three groups:PPOS protocol group(n=44),antagonist protocol group(n=177)and ultralong protocol group(n=170).The general basic data,COS process data,embryo laboratory data and pregnancy outcomes were compared among the three groups.Results:The general data of the three groups were comparable(P>0.05).The total days and dose of gonadotropin(Gn)used in PPOS protocol group and ultralong protocol group were significantly higher,and the levels of LH,E_(2)and progesterone on HCG day were significantly lower than those in antagonist protocol group(P<0.05).Compared with the ultralong protocol group,the levels of LH and E_(2)on HCG day in the PPOS protocol group were significantly higher(P<0.05),and there was no significant difference in other indicators(P>0.05).The number of oocytes retrieved,incidence of OHSS and cumulative pregnancy rate in PPOS protocol group were significantly lower than those in the antagonist protocol group and ultralong protocol group groups(P<0.05).The utilization rate of oocyte in PPOS protocol group and antagonist protocol group was significantly higher than that in the ultralong protocol group(P<0.05),but there was no significant difference between PPOS protocol group and antagonist protocol group(P>0.05).The cleavage rate of PPOS protocol group was significantly higher than that of antagonist protocol group and ultralong protocol group(P<0.05).There was no significant difference in the abortion rate among the three groups(P>0.05).In the fresh embryo transfer cycle,the persistent pregnancy rate of the ultralong protocol group was signific
作者
徐佳贝
陈娇
杨菁
XU Jia-bei;CHEN Jiao;YANG Jing(Reproductive Medical Center,Renmin Hospital of Wuhan University,Wuhan430000)
出处
《生殖医学杂志》
CAS
2023年第3期332-338,共7页
Journal of Reproductive Medicine
基金
国家自然科学基金(81771618,81971356)。
