论文部分内容阅读
目的:探讨在高孕激素状态下促排卵治疗（progestin-primed ovarian stimulation，PPOS）的卵泡晚期应用低剂量的人绒毛膜促性腺激素（human chorionic gonadotropin， hCG）替代人绝经期促性腺激素（human menopausal gonadotropin，hMG）对多囊卵巢综合征（polycystic ovary syndrome， PCOS）患者体外受精（n in vitro fertilization， IVF）/卵胞质内单精子注射（intracytoplasmic sperm injection， ICSI）结局的影响。n 方法:回顾性队列研究分析2015年3月至2017年12月期间在上海交通大学医学院附属第九人民医院辅助生殖科行IVF/ICSI治疗的PCOS患者的临床资料。促排卵方案均采用PPOS，根据PPOS的卵泡晚期是否应用低剂量的hCG替代hMG分组：A组，PPOS常规方案组（hMG+孕酮），完全应用hMG（141个周期）；B组，PPOS卵泡晚期hCG替代hMG组（hMG/hCG+孕酮），即在PPOS促排卵治疗的卵泡晚期应用低剂量的hCG（200 IU/d）完全替代hMG（80个周期）。比较两组患者的临床资料和妊娠相关指标。本研究的主要监测指标包括获卵数、可用胚胎数和临床妊娠率。结果:两组的促排卵治疗时间［A组（9.7±2.6） d比B组（10.3±3.4） d］差异无统计学意义（n P=0.16）；B组hMG用药时间［（7.8±3.5） d］及hMG用药量［（1 592.8±840.5） IU］均显著低于A组［（9.7±2.6） d，n P=0.01；（1 825.2±795.3） IU，n P=0.04］；两组的获卵数和可用胚胎数差异均无统计学意义（n P>0.05）。在随后的冻融胚胎移植（frozen-thawed embryo transfer， FET）周期中，A组与B组间患者的临床妊娠率［52.8%（105/199）比49.2%（60/122）］、胚胎种植率［37.1%（139/375）比37.1%（86/232）］、早期流产率［4.8%（5/105）比5.0%（3/60）］及持续妊娠率［47.7%（95/199）比44.3%（54/122）］差异均无统计学意义（n P>0.05）。n 结论:PCOS患者在PPOS的卵泡晚期应用低剂量的hCG替代hMG，能安全、有效地维持卵泡生长发育，且不影响PCOS患者的IVF/ICSI-FET治疗的结局。“,”Objective:To investigate the effect of low dosage of human chorionic gonadotropin (hCG) replacing human menopausal gonadotropin (hMG) in the late follicular stage during progestin-primed ovarian stimulation (PPOS) on the outcome of n in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) for polycystic ovary syndrome (PCOS) patients.n Methods:The patients with PCOS who underwent IVF/ICSI-frozen-thawed embryo transfer (FET) treatment in the Department of Assisted Reproduction of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to December 2017 were retrospectively analyzed. Ovarian stimulation adopted PPOS. According to whether low dosage of hCG was used to replace hMG in the late follicular stage of PPOS, they were divided into two groups: group A, PPOS routine group (hMG + progesterone), complete application of hMG (141 cycles); group B, hMG/hCG+progesterone, low dosage of hCG (200 IU/d) was used to completely replace hMG in the late follicular stage of PPOS (80 cycles). The clinical data and pregnancy related indexes of the two groups were compared. The main outcome measures included the number of oocytes retrieved, the number of available embryos and clinical pregnancy rate.Results:There was no significant difference in the duration of ovarian stimulation between group A and group B [(9.7±2.6) d n vs. (10.3±3.4) d, n P=0.16]. The duration of hMG administration [(7.8±3.5) d] and the dosage of hMG [(1 592.8±840.5) IU] in group B were significantly lower than those in group A [(9.7±2.6) d,n P=0.01; (1 825.2±795.3) IU, n P=0.04]. There were no significant differences in the number of oocytes retrieved (17.3±8.9 n vs.17.8±8.8) and the number of available embryos (6.2±4.1 n vs. 6.0±3.2) between the two groups (n P>0.05). In the subsequent FET cycle, the clinical pregnancy rate [52.8% (105/199)n vs. 49.2% (60/122)], the embryo implantation rate [37.1% (139/375) n vs. 37.1% (86/232)], the early abortion rate [4.8% (5/105) n vs. 5.0% (3/60)] and the ongoing pregnancy rate [47.7% (95/199) n vs. 44.3% (54/122)] were not statistically different between group A and group B.n Conclusion:The use of low dosage of hCG instead of hMG in the late follicular stage of PPOS in patients with PCOS, which can safely and effectively maintain follicular growth and development, without affecting the outcome of IVF/ICSI-FET for PCOS patients.