多囊卵巢综合征患者改良超长方案联合重组促性腺激素超排卵疗效评价

摘要

Objective: To evaluate the effectiveness and safety of the modified super-long protocol using gonadotrophin releasing hormone agonist(GnRH-a)combined with recombinant gonadotropin in controlled ovarian stimulation for polycystic ovarian syndrome (PCOS) patients undergoing in vitro fertilization and embryo transfer(IVF-ET).rnMethods: This was a prospective,single center,observational study,which enrolled 42 PCOS patients who were admitted for IVF-ET from Feb. 2011 to Dec. 2011. The patients pre-treated with an oral contraceptive for one cycle were down-regulated with an intramuscular injection of 1.5 mg~l. 85 mg gonadotrophin releasing hormone agonist(GnRH-a)during the mid-luteal phase for two menstrual cycles. Recombinant human follicle stimulating hormone(r-FSH) and luteinizing hormone (r-LH) were initiated at the 13th to 20th days after the last GnRH-a injection. The analysis included number of oocytes retrieved, number of embryos,pregnancy rate,as well as the cycles cancelled and adverse events profiles.rnResults: All 42 patients met eligibility criteria and had oocytes retrieved (median, 14. 36 ± 4.92).rnEmbryos were available for 41 patients; 37 patients underwent ET with the clinical pregnancy rate of 70. 3%(26/37)(95% CI, 55. 54% to 85%) and implantation rate of 47. 2% (42/89) . Five cycles were cancelled. One patient suffered severe ovarian hyperstimulation syndrome (OHSS) and no patient experienced the symptoms of low estrogen level associated with prolonged down-regulation.rnConclusions: Treatment of PCOS patients with a modified super-long GnRH-a protocol combined with r-hFSH and r-hLH may achieve an adequate number of oocytes with high implantation rates and clinical pregnancy rates as well as low risk of OHSS, without symptoms of estrogen deprivation.%目的 评价多囊卵巢综合征(PCOS)患者改良超长方案联合使用重组促性腺激素超促排卵的有效性和安全性.方法 本试验是前瞻性、单中心、观察性研究.从2011年2月至2011年12月在中信湘雅生殖与遗传专科医院生殖中心共招募42例PCOS合并输卵管不育或男性因素不育患者.使用改良超长方案,自月经周期第2～3天口服达英-35 1粒/d×18,之后肌肉注射促性腺激素释放激素激动剂(GnRH-a)1.5～1.85 mg,第2个月经周期第21天再次注射相同剂量GnRH-α末次注射后13～20 d开始使用重组卵泡刺激素(rFSH)和重组黄体生成素(rLH)卵巢刺激行体外受精-胚胎移植(IVF-ET).对取卵数、胚胎数、妊娠率进行分析,同时评价周期取消及不良事件发生情况. 结果 42例完全符合方案,全部取得卵母细胞,平均获卵数为(14.36±4.92)个,41例患者均获得胚胎,37例患者进行胚胎移植,临床妊娠率为70.3％ (26/37) (95％ CI55.54％～85％),种植率47.2％(42/89),5例周期取消.发生重度卵巢过度刺激综合征(OHSS)1例.没有患者出现低雌激素症状. 结论 PCOS患者使用改良超长方案联合重组促性腺激素可获得适当数量卵母细胞,临床妊娠率和种植率高,未发现有低雌激素症状发生,OHSS风险低.