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目的分析多囊卵巢综合征(PCOS)患者经促性腺激素释放激素激动剂(GnR H-a)长方案降调节超促排卵发生卵巢慢反应的可能原因,为PCOS患者预测卵巢慢反应发生、探寻个体化的促排卵方案提供参考。方法回顾性分析2012年6月至2014年8月在中南大学湘雅医院生殖中心实施体外受精(IVF)或卵胞浆内单精子注射(ICSI)常规长方案降调节治疗的PCOS不孕患者的临床资料,依据超促排卵(COH)天数、卵泡生长情况、人绒毛膜促性腺激素(HCG)日雌二醇(E2)浓度及获卵数将PCOS患者分为卵巢慢反应组162个周期,卵巢正常反应组136个周期,卵巢高反应组141个周期。比较不同卵巢反应组间患者基础情况及治疗情况的相关指标。采用单因素方差分析及多因素Logistic逐步回归进行统计分析。结果慢反应组与正常反应组及高反应组比较,体重指数、基础卵泡刺激素(FSH)、启动日窦卵泡数(AFC)、促性腺激素(Gn)起始量差异有统计学意义(P<0.05),但3组间年龄、基础睾酮、降调天数、启动日E2差异无统计学意义(P>0.05)。Logistic逐步回归分析显示体重指数(OR=1.792,P=0.006)、基础FSH(OR=2.933,P=0.000)、启动日AFC(OR=1.459,P=0.039)为慢反应发生的危险因素;而FSH起始量(OR=0.468,P=0.001)、启动日黄体生成激素(LH)(OR=0.713,P=0.014)、口服避孕药预处理(OR=0.081,P=0.000)为保护因素。结论 PCOS患者卵巢慢反应发生与体重指数增加、降调后LH水平偏低、窦卵泡数过多、Gn起始剂量不足相关,超促排卵前口服避孕药预处理为保护性因素。超促排卵前尽量纠正PCOS患者的内分泌及代谢紊乱、合理的个体化促排卵可能降低卵巢慢反应的发生风险。
OBJECTIVE: To analyze the possible causes of slow ovarian response in patients with polycystic ovary syndrome (PCOS) by long protocol of gonadotropin-releasing hormone agonist (GnR Ha), to predict the occurrence of ovarian slow reaction in PCOS patients and to explore individualization Ovulation program to provide a reference. Methods A retrospective analysis was conducted between June 2012 and August 2014 in infertile women with PCOS who underwent routine long-term regimen of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the Reproductive Center of Xiangya Hospital of Central South University Clinical data were divided into 162 cycles of ovarian slow reaction group according to the number of COH days, the growth of follicles, the concentration of estradiol (E2) of human chorionic gonadotropin (HCG) 136 cycles of normal ovarian response group and 141 cycles of high ovarian response group. Compare different patients with ovarian response based on the patient’s condition and treatment of related indicators. One-way ANOVA and multivariate Logistic stepwise regression were used for statistical analysis. Results Compared with normal group and high-response group, there were significant differences in body mass index, basal follicle stimulating hormone (FSH), start of antral follicle count (AFC) and gonadotropin (Gn) <0.05). However, there was no significant difference in age, basal testosterone, days of down-regulation and start-up E2 between the three groups (P> 0.05). Logistic stepwise regression analysis showed that body mass index (OR = 1.792, P = 0.006), basal FSH (OR = 2.933, P = 0.000) and AFC (1.459, P = 0.039) The initial amount of FSH (OR = 0.468, P = 0.001) and the initiation of luteinizing hormone (LH) (OR = 0.713, P = 0.014) and oral contraceptive pretreatment (OR = 0.081, P = 0.000) Conclusion PCOS patients with slow response to ovarian tissue and body mass index increased, decreased LH level after low, antral follicles too much, Gn initial lack of dose-related, super-ovulation oral contraceptive pretreatment as a protective factor. Ovulation before ovulation as far as possible to correct the endocrine and metabolic disorders in patients with PCOS, rational individual ovulation may reduce the risk of ovarian slow reaction.