拮抗剂方案在行体外受精-胚胎移植的多囊卵巢综合症患者中的应用

摘要

Objective To discuss the application of GnRH antagonist protocol in vitro fertilization-embryo transfer (IVF-ET) in PCOS patients. Methods 141 PCOS patients who undergoing IVF/ICSI treatment in our center from June 2013 to April 2014 were randomly divided into two groups:62 patients who underwent GnRH antagonist protocol and 79 patients who underwent long GnRH agonist protocol (control group). The baseline,clinical outcomes and complications were compared between the two groups. Results The baselines of two groups compared were not statistically different (P>0.05). There were no significant difference of re-trieved oocytes,2PN fertilization rate,cleavage rate,numbers of embryo transferred,endometrial thickness,serum E2 and P value on the day of HCG administration,clinical pregnancy rate and implantation rate between the two groups (P>0.05). The total dose and stimulation time of gonadotropin in antagonist group were less than the control group (P<0.05);the high qualified embryo rate was higher in GnRH antagonist protocol (P<0.05);serum LH level on the day of HCG administration in antagonist protocol was higher (P<0.05). The incidence of moderate and severe OHSS in antagonist protocol was less than the control group,but the differ-ence was not statistically significance (P>0.05). Conclusion Compared with the GnRH agonist protocol,the GnRH antagonist pro-tocol can reduce the incidence of moderate and severe ovarian hyperstimulation syndrome,and has the same effect in retrieving oocytes,2PN fertilization rate,cleavage rate,implantation rate,and clinical pregnancy rate. Because the GnRH antagonist can de-crease the treatment duration and cost,and has better safety,so it may be an ideal choice for PCOS patients to have IVF-ET thera-py.%目的：探讨促性腺激素释放激素拮抗剂（GnRH-ant）方案在多囊卵巢综合症（polycystic ovary syndrome，PCOS）患者行体外受精-胚胎移植（In Vitro Fertilization-Embryo Transfer，IVF-ET）治疗中的应用。方法将2013年6月至2014年4月在我中心行IVF/ICSI助孕治疗的141例PCOS患者随机分为两组：GnRH拮抗剂组62例和GnRH激动剂长方案组（对照组）79例，比较两组的基线水平、临床结局及并发症等指标。结果两组患者的基线水平指标相比均无统计学差异（P>0.05）。两组获卵数、2PN受精率、卵裂率、移植胚胎数、HCG日内膜厚度、HCG日E2及P水平、临床妊娠率、种植率比较均无明显差异（P>0.05）；拮抗剂组Gn总量及天数均少于对照组（P<0.05）；拮抗剂组优胚率比对照组高（P<0.05）；拮抗剂组HCG日LH的水平高于对照组（P<0.05），差异有统计学意义。拮抗剂组中、重度OHSS发生率与对照组比较差异无统计学意义。结论拮抗剂方案较激动剂方案能降低OHSS发生风险，而获卵数、受精率、卵裂率、种植率、临床妊娠率方面不受影响；拮抗剂方案能缩短治疗周期、降低治疗费用，具有较好的有效性和安全性，对PCOS患者行是一种比较理想的选择。