Abstract:

Abstract： Objective To compare the clinical outcomes among different IVM protocols for PCOS patients.Methods PCOS patients in our hospital from Jan.2010 to Dec.2012.were divided into three groups retrospectively.Group A(n=140).routine IVM; Group B(n=152),low dose gonadotrophin stimulating IVM and Group C(n=505),long protocol group.The clinical outcomes of these three groups were compared.Results (1) The clinical pregnancy rates of group B and C showed no significant differences and were significantly higher than group A.(2) The endometrial thickness on the day of HCG injection of group B was more than A.（3）The quality embryos rates of three groups had significant differences.(4)The dose of Gn for group A and B was statistically less than C.(5)There was no OHSS in group A or B;the severe OHSS rate in group C was 2.18%.Conclusions IVM can avoid occurance of OHSS.Routine IVM after the low dosage stimulation of Gn after downregulation can obtain similar clinical pregnancy rate to long protocol IVF.IVM is a safer and effective method for PCOS patients.

Key words: PCOS, IVM, IVF-ET, OHSS

摘要：

目的 探讨对多囊卵巢综合征（PCOS）患者行未成熟卵母细胞体外培养技术（IVM）助孕治疗的有效方案。方法 对2010年1月至2012年12月在中信湘雅生殖与遗传专科医院接受体外受精（IVF）助孕治疗的PCOS患者进行回顾性分析。按助孕方案分3组：A组：自然周期IVM（140例）；B组：促性腺激素释放激素激动剂（GnRH-a）+短暂重组卵泡刺激素（r-FSH）刺激再行IVM(152例)；C组：长方案降调节后常规体外受精-胚胎移植(505例)。分别比较3种助孕方案对PCOS患者的疗效。结果 （1）临床妊娠率：B组52.59％，C组58.35％，差异无统计学意义（P>0.05），但均明显高于A组（32.23％）（P<0.05）。（2）人绒毛膜促性腺激素（HCG）日内膜厚度：A组（5.99±1.96）mm，B组（7.87±2.14）mm，C组（11.81±2.20）mm，3组比较差异均有统计学意义（P<0.05）。（3）优胚率：A组（47.23±29.17）%，B组（59.95±30.43）%，C组（65.66±23.35）%，3组比较差异均有统计学意义（P<0.05）。（4）促性腺激素（Gn）用量：A组未使用Gn，B组（600.08±291.21）U，C组（1776.36±693.76）U，3组比较差异均有统计学意义（P<0.05）。（5）并发症发生率：A、B组无卵巢过度刺激综合征（OHSS）发生，C组重度OHSS发生率为2.18％。结论 IVM方案可以有效避免PCOS患者促排卵时OHSS发生，降调节后短暂Gn刺激再行IVM助孕，可以获得与传统长方案IVF相似的临床妊娠率，是PCOS患者经济、安全有效的助孕方式。

关键词: 多囊卵巢综合征, 未成熟卵母细胞体外培养, 体外受精-胚胎移植, 卵巢过度刺激综合征