多囊卵巢综合征年轻不孕患者体外受精-胚胎移植结局研究

doi:10.7504/fk2014060114

摘要/Abstract

摘要：

目的探讨对<35岁多囊卵巢综合征（PCOS）不孕患者行体外受精-胚胎移植 (in vitro fertilization and embryo transfer, IVF-ET)受孕后的结局。方法选取2007年10月至2010年8月间在中山大学附属第一医院生殖中心第一次行IVF的<35岁PCOS患者共68例，对照组为<35岁的第一次行IVF的输卵管性不孕患者共1164例。对两组患者的基本资料、IVF-ET周期的卵子和胚胎情况以及妊娠结局进行回顾性比较。结果　<35岁PCOS患者IVF周期中的临床妊娠率（30.9% vs. 44.1%）、流产率（14.3% vs.12.9%）、多胎率（42.9% vs. 38.4%）、早产率（22.2 %vs.14.7%）、小于胎龄儿（9.5% vs.11.1%）以及大于胎龄儿（9.5% vs. 3.1%），与对照组患者比较，差异无统计学意义（P>0.05），但其妊娠期糖尿病（14.3% vs.4.1%）以及妊娠期高血压疾病（4.0% vs. 1.0%）的发生率高于对照组，差异有统计学意义（P<0.05）。结论 <35岁PCOS不孕患者行IVF-ET治疗后的妊娠期糖尿病、妊娠期高血压疾病的发生率增加。

关键词: 多囊卵巢综合征, 体外受精-胚胎移植

Abstract:

Abstract： Objective To investigate the pregnancy outcome women with age <35 years polycystic ovary syndrome (PCOS) compared with control groups after in vitro fertilization and embryo transfer (IVF-ET). Methods Women with PCOS who underwent the first time of IVF between October 2007 and August 2010 were considered. A total of 68 PCOS patients and 1164 patients with tubal infertility were included, and reviewed focusing on the basal characteristics, IVF-ET outcomes, and pregnancy outcomes. Results The clinical pregnancy rate（30.9% vs. 44.1%）, miscarriage rate (14.3% vs. 12.9%), multiple pregnancy rate (42.9% vs. 38.4%), preterm delivery rate (22.2% vs. 14.7%), small for gestational age (SGA) (9.5 %vs. 11.1%) infant and large for gestational age (LGA) infant (9.5% vs. 3.1%) rate were not different between two groups (P>0.05). On the other hand, the morbidity of gestational diabetes mellitus (GDM) (14.3% vs. 4.1%) and hypertensive disorder complicating pregnancy (HDCP) (4.0% vs. 1.0%) was significantly higher than those in control group (P<0.05). Conclusion Age <35 years PCOS patients after IVF-ET did not present various higher pregnancy complications, but they presented some worse pregnancy outcomes, especially in GDM and HDCP.

Key words: polycystic ovary syndrome, in vitro fertilization and embryo transfer

中图分类号:

R711.6

张丹，徐艳文，王子莲，王增艳，王琼，苗本郁，周灿权. 多囊卵巢综合征年轻不孕患者体外受精-胚胎移植结局研究[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014060114.

ZHANG Dan.. Pregnancy outcomes of young patients with polycystic ovary syndrome after in vitro fertilization and embryo transfer.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014060114.

参考文献

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［2］    Heijnen EM, Eijkemans MJ, Hughes EG, et al. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome［J］. Hum Reprod Update,2006,12(1):13-21.

［3］   Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome［J］. Semin Reprod Med,2008,26(1):72-84.

［4］   Qiao J, Feng HL. Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence［J］. Hum Reprod Update,2011,17(1):17-33.

［5］   Savaris RF, Groll JM, Young SL, et al. Progesterone resistance in PCOS endometrium: a microarray analysis in clomiphene citrate-treated and artificial menstrual cycles［J］. J Clin Endocrinol Metab,2011,96(6):1737-1746.

［6］   Revel A. Defective endometrial receptivity［J］. Fertil Steril,2012,97(5):1028-1032.

［7］   Shapiro BS, Daneshmand ST, Garner FC, et al. Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders［J］. Fertil Steril,2011,96(2):344-348.

［8］   Lohsoonthorn V, Qiu C, Williams MA. Maternal serum C-reactive protein concentrations in early pregnancy and subsequent risk of preterm delivery［J］. Clin Biochem,2007,40(5-6):330-335.

［9］   Palomba S, Falbo A, Russo T, et al. Uterine blood flow in pregnant patients with polycystic ovary syndrome: relationships with clinical outcomes［J］. BJOG,2010,117(6):711-721.

［10］   De Leo V, Musacchio MC, Piomboni P, et al. The administration of metformin during pregnancy reduces polycystic ovary syndrome related gestational complications［J］. Eur J Obstet Gynecol Reprod Biol,2011,157(1):63-66.

［11］   Palomba S, Falbo A, Orio FJ, et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials［J］. Fertil Steril,2009,92(5):1646-1658.

［12］   Tang T, Lord JM, Norman RJ, et al. WITHDRAWN: Insulin-sensitising drugs for polycystic ovary syndrome［J］. Cochrane Database Syst Rev,2009(3):D3053.

［13］   Kashyap S, Claman P. Obstetric outcome in women with polycystic ovarian syndrome［J］. Hum Reprod,2001,16(7):1537.

［14］   Sir-Petermann T, Hitchsfeld C, Maliqueo M, et al. Birth weight in offspring of mothers with polycystic ovarian syndrome［J］. Hum Reprod,2005,20(8):2122-2126.

［15］   Toulis KA, Goulis DG, Kolibianakis EM, et al. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis［J］. Fertil Steril,2009,92(2):667-677.

（2014-01-15收稿    2014-04-20修回）［1］   Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)［J］. Hum Reprod,2004,19(1):41-47.

［2］    Heijnen EM, Eijkemans MJ, Hughes EG, et al. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome［J］. Hum Reprod Update,2006,12(1):13-21.

［3］   Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome［J］. Semin Reprod Med,2008,26(1):72-84.

［4］   Qiao J, Feng HL. Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence［J］. Hum Reprod Update,2011,17(1):17-33.

［5］   Savaris RF, Groll JM, Young SL, et al. Progesterone resistance in PCOS endometrium: a microarray analysis in clomiphene citrate-treated and artificial menstrual cycles［J］. J Clin Endocrinol Metab,2011,96(6):1737-1746.

［6］   Revel A. Defective endometrial receptivity［J］. Fertil Steril,2012,97(5):1028-1032.

［7］   Shapiro BS, Daneshmand ST, Garner FC, et al. Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders［J］. Fertil Steril,2011,96(2):344-348.

［8］   Lohsoonthorn V, Qiu C, Williams MA. Maternal serum C-reactive protein concentrations in early pregnancy and subsequent risk of preterm delivery［J］. Clin Biochem,2007,40(5-6):330-335.

［9］   Palomba S, Falbo A, Russo T, et al. Uterine blood flow in pregnant patients with polycystic ovary syndrome: relationships with clinical outcomes［J］. BJOG,2010,117(6):711-721.

［10］   De Leo V, Musacchio MC, Piomboni P, et al. The administration of metformin during pregnancy reduces polycystic ovary syndrome related gestational complications［J］. Eur J Obstet Gynecol Reprod Biol,2011,157(1):63-66.

［11］   Palomba S, Falbo A, Orio FJ, et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials［J］. Fertil Steril,2009,92(5):1646-1658.

［12］   Tang T, Lord JM, Norman RJ, et al. WITHDRAWN: Insulin-sensitising drugs for polycystic ovary syndrome［J］. Cochrane Database Syst Rev,2009(3):D3053.

［13］   Kashyap S, Claman P. Obstetric outcome in women with polycystic ovarian syndrome［J］. Hum Reprod,2001,16(7):1537.

［14］   Sir-Petermann T, Hitchsfeld C, Maliqueo M, et al. Birth weight in offspring of mothers with polycystic ovarian syndrome［J］. Hum Reprod,2005,20(8):2122-2126.

［15］   Toulis KA, Goulis DG, Kolibianakis EM, et al. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis［J］. Fertil Steril,2009,92(2):667-677.

（2014-01-15收稿    2014-04-20修回）

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