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多囊卵巢综合征不孕患者辅助生殖治疗临床效果分析

Clinical analysis of assistant treatment proposals for infertile women with polycystic ovary syndrome

摘要:

目的 探讨多囊卵巢综合征(PCOS)不孕患者辅助生殖治疗的临床效果及方案选择.方法 回顾性分析2003年1月至2007年11月间,在山东大学附属省立医院生殖医学中心就诊的PCOS不孕患者的临床资料,根据治疗方案不同,分为药物治疗[分别用来曲唑(LE组,58个周期)或枸橼酸氯米芬(CC组,45个周期)]、体外受精-胚胎移植(IVF-ET)治疗、经阴道B超未成熟卵泡穿刺治疗、未成熟卵体外成熟(IVM)治疗等方案,分析其临床效果.结果 (1)药物治疗者中,LE组排卵率为66%(38/58),Cc组为47%(21/45);人绒毛膜促性腺激素(hCG)注射日平均子宫内膜厚度,LE组为(0.89±0.13)cm,CC组为(0.78±0.08)cm;hCG注射日宫颈黏液评分,LE组为(11.9±1.8)分,CC组为(9.9±1.8)分;平均成熟卵泡数,LE组为(1.08±0.28)个,CC组为(1.73±0.59)个;hCG注射日平均雌二醇水平,LE组为(983±138)pmol/L,CC组为(1676±372)pmol/L,两组各项指标比较,差异均有统计学意义(P<0.05);LE组周期妊娠率为14%(8/58),CC组为13%(6/45),两组比较,差异无统计学意义(P>0.05).(2)IVF-ET治疗者中,1584例PCOS不孕患者(PCOS组)促性腺激素(Gn)总用量[(980±1192)IU]低于对照组[(1194±1389)IU,同期因输卵管因素行IVF-ET治疗者1615例],但两组使用Gn平均天数[分别为(9.6±1.8)、(9.5±1.8)d]、hCG注射日平均雌二醇水平[分别为(15 752±6206)、(9675±4818)pmol/L]、平均获卵数[分别为(21±6)、(9±3)个]、平均受精数[分别为(15±6)、(7±3)个]、平均卵裂数[分别为(12.9±5.7)、(5.7±2.8)个]和重度卵巢过度刺激综合征(OHSS)发生率(分别为4.86%、1.67%)比较,PCOS组均明显高于对照组,差异均有统计学意义(P<0.05).但两组临床妊娠率(分别为44.7%、45.0%)比较,差异无统计学意义(P>0.05).(3)109例经阴道B超未成熟卵泡穿刺治疗患者的睾酮和黄体生成素水平均较治疗前明显下降,卵巢基础窦卵泡计数随穿刺次数增加而减少.穿刺治疗后应用尿促性腺激素促排卵治疗时,OHSS发生率很低,穿刺治疗后妊娠率达50%以上.(4)IVM治疗的286例PCOS不孕患者,取卵周期304个,平均每周期取卵12.3个,有76例患者获得临床妊娠.结论 PCOS不孕患者治疗的选择方案较多,上述4种治疗方案均有效,应结合患者具体情况给予个体化处理.

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abstracts:

Objective To study the clinical outcomes of assistant treatment proposals for infertile women with polycystic ovary syndrome (PCOS). Methods PCOS patients were divided into four groups according to the assistant treatment proposals between Jan 2003 and Dec 2007 in Reproductive Medicine Center of the Provincial Hospital Affiliated to Shandong University. The four proposals were letrozole(LE) or clomiphene(CC) citrate ovulation induction group, in vitro fertilization and embryo transplantation group, ultrasound-guided immature follicle puncture group, and in vitro maturation and fertilization of oocytes from unstimulated cycles group. The treatment results were analyzed. Results (1) The ovulation rate was 66% (38/58) vs 47% (21/45). The mean endometrial thickness [ (0. 89±0. 13) vs (0. 78±0. 08) cm] and cervical mucus score (11.9±1.8 vs 9. 9±1.8 ) on the day of human chorionic gonadotropin ( hCG ) administration in LE group were both higher than that in CC group, while mature follicle ( 1.08±0. 28 vs 1.73±0. 59) and serum estradiol level [ (983±138) vs (1676±372) pmol/L] in LE group were lower than that in CC group(P <0. 05). (2) One southend five hundred and eighty-four patients accepted in vitro fertilization-embryo transplantation therapy because of PCOS (PCOS group) and 1615 patients because of tube factors (control group). The patients′ ages and infertility years were matched between the two groups. Total doses of Gn [ (980±1192) vs ( 1194±1389) IU] of PCOS group were lower than those of control group. The mean days of using gonadotropin [ (9.6±1.8) vs (9. 5±1. 8) d], serum estradiol (E2) levels on the hCG day [ ( 15 752±6206) vs (9675±4818) pmol/L], mean obtained oocytes (21±6 vs 9±3), mean fertilized oocytes ( 15±6 vs 7±3) and mean cleavaged oocytes ( 12. 9±5.7 vs 5.7±2. 8 ) of PCOS group were higher than those of the control group( P < 0. 05 ). Moderate and severe ovarian hyperstimulation syndrome (OHSS) rates (4. 86% vs 1.67% ) of PCOS group were higher than that of the control group. The pregnant rate (44. 7% vs 45.0% ) of PCOS group was similar to the control group ( P > 0. 05 ). (3) One hundred and nine PCOS patients were given ultrasound-guided immature follicle puncture therapy. After treatment, the testosterone level, luteinizing hormone (LH) level and LH/follicle stimulating hormone (FSH) ratio of the patients became normal. The basic follicle number decreased. (4) A total of 304 in vitro maturation cycles were performed. After embryo transfer, 76 pregnancies were reported. Conclusions There are many choices for the infertile patients with PCOS, such as LE or CC citrate ovulation induction, in vitro fertilization and embryo transplantation, ultrasound-guided immature follicle puncture, and in vitro maturation and fertilization of oocytes from unstimulated cycles. We can provide individualized treatment according to the medical treatment conditions, doctors′ professional capability and the patients′ situation.

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作者: CHEN Zi-jiang SHI Yu-hua 李媛 GAO Qin 盛燕 MA Zeng-xiang
期刊: 《中华妇产科杂志》2008年43卷8期 571-575页 MEDLINEISTICPKUCSCDCA
分类号: R71
栏目名称: 辅助生殖
DOI: 10.3321/j.issn:0529-567X.2008.08.005
发布时间: 2008-10-13
基金项目:
国家自然科学基金 国家高技术研究发展计划(863计划)
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