Role of the proportion of dominant follicles in patients with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer
Role of the proportion of dominant follicles in patients with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer
复制标题
优势卵泡比例在多囊卵巢综合征患者体外受精-胚胎移植中的作用
DOI：
10.1097/cm9.0000000000000246
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发表时间：
2019-06-20
影响因子：
6.1
通讯作者：
Li, Yi
中科院分区：
文献类型：
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作者：
Lin, Hai-Yan;Li, Yu;Li, Yi
摘要背景：对于最佳触发时间没有绝对的共识。本研究的目的是探讨不同比例的优势卵泡（PDF）对人绒毛膜促性腺激素（HCG）日的影响，对不同卵巢刺激方案的多囊卵巢综合征（PCOS）患者的临床结果的影响。方法：本回顾性研究纳入2014年1月至2016年12月期间共371个周期的促性腺激素释放激素（GnRH）激动剂长方案和347个周期的GnRH拮抗剂方案。根据HCG给药当天的PDF，将纳入的患者分为三组：A组（低PDF），PDF<20%； B组（中PDF），20%≤PDF≤40%； C 组（高 PDF），PDF >40%。比较不同方案下不同PDF组的卵巢刺激特征、受精率、优质胚胎率、临床妊娠率和卵巢过度刺激综合征（OHSS）率的测量结果。结果：在 GnRH 拮抗剂方案和 GnRH 激动剂长方案中，组间的平均年龄、抗缪勒氏管激素、窦卵泡计数 (AFC) 和体重指数等特征具有可比性。随着 PDF 和成熟卵母细胞率的增加，回收的卵母细胞数量显着减少。在GnRH激动剂长方案中，A组正常受精卵母细胞率最高（59.74 ± 31.21 vs. 49.70 ± 37.95、49.67 ± 36.62；F = 3.743，P = 0.025）。各组间优质胚胎率及临床妊娠率无显着差异。三组临床妊娠率相似（分别为63.6%、62.5%、67.5%，χ2 = 0.989，P = 0.911）。随着PDF的增加，中重度OHSS发生率显着增加，其中C组最高（分别为1.4%、3.1%、6.7%，χ2 = 12.014，P = 0.017）。 GnRH拮抗剂方案中，各组间优质胚胎率、正常受精卵率、临床妊娠率、中重度OHSS率无显着差异。 C组临床妊娠率高于A组（57.9%比46.6%，χ2 = 10.850，P = 0.093）。结论：在GnRH拮抗剂方案中，HCG日PDF低于20%可能不利于PCOS的临床妊娠率。在GnRH激动剂长方案中，延迟HCG触发时机对临床妊娠没有良好影响，并且PCOS患者发生OHSS的风险可能增加。
Abstract Background: There is no absolute consensus for the best time for triggering. The aim of this study was to investigate the effect of different proportion of dominant follicles (PDF) on the human chorionic gonadotropin (HCG) day for the clinical outcomes in patients with polycystic ovary syndrome (PCOS) of different ovarian stimulation protocols. Methods: A total of 371 cycles of the gonadotropin-releasing hormone (GnRH) agonist long protocol and 347 cycles of GnRH antagonist protocol from January 2014 to December 2016 were included in this retrospective study. Based on the PDF on the day of the HCG administration, the included patients were divided into three groups: Group A (low PDF), PDF <20%; Group B (medium PDF), 20%≤ PDF ≤40%; Group C (high PDF), PDF >40%. The measurements regarding ovarian stimulation characteristics, fertilization rate, top quality embryo rate, clinical pregnancy rate, and ovarian hyperstimualtion syndrome (OHSS) rate were compared in different PDF groups with different protocols. Results: In both the GnRH antagonist protocol and GnRH agonist long protocol, the characteristics such as mean age, anti-Mullerian hormone, antral follicle count (AFC), and body mass index were comparable between groups. The number of oocytes retrieved decreased statistically significantly as the PDF and rate of matured oocytes increased. In the GnRH agonist long protocol, the rate of normally fertilized oocytes was highest in Group A (59.74 ± 31.21 vs. 49.70 ± 37.95, 49.67 ± 36.62; F = 3.743, P = 0.025). There were no significant differences in the rate of top-quality embryos and the clinical pregnancy rate between the groups. The clinical pregnancy rate was similar in the three groups (63.6%, 62.5%, 67.5%, respectively, χ2 = 0.989, P = 0.911). The moderate and severe OHSS rate increased statistically significantly when the PDF increased, which was highest in group C (1.4%, 3.1%, 6.7%, respectively, χ2 = 12.014, P = 0.017). In the GnRH antagonist protocol, there were no significant differences in the rate of top-quality embryos, the rate of normally fertilized oocytes, the clinical pregnancy rate, and the moderate and severe OHSS rate between the groups. The clinical pregnancy rate in Group C was higher than that in Group A (57.9% vs. 46.6%, χ2 = 10.850, P = 0.093). Conclusions: In the GnRH antagonist protocol, PDF on the HCG day of less than 20% may be unfavorable to the clinical pregnancy rate in PCOS. In the GnRH agonist long protocol, delaying the HCG trigger timing has no good effect on clinical pregnancy and the risk of OHSS might increase in patients with PCOS.