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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(Gn RH-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。
Objective To investigate the effective treatment of pregnancy induced by immature oocyte in vitro culture (IVM) in patients with polycystic ovary syndrome (PCOS). Methods A retrospective analysis was performed on patients with PCOS undergoing in vitro fertilization (IVF) assisted pregnancy from January 2010 to December 2012 at the Xiangya Reproductive and Genetic College of CITIC. According to the scheme of pregnancy-conferring, there are 3 groups: Group A: IVM (140 cases); Group B: Gn RH-a + r-FSH (N = 152). Group C: routine off-fertilization-embryo transfer after long-term regimen (n = 505). The effects of three kinds of pregnancy-assisted programs on patients with PCOS were compared. Results (1) The clinical pregnancy rate was 52.59% in group B and 58.35% in group C, but the difference was not statistically significant (P> 0.05), but both were significantly higher than those in group A (32.23%) (P <0.05). (2) The thickness of intima-media thickness of human chorionic gonadotropin (HCG) in group A was (5.99 ± 1.96) mm, in group B (7.87 ± 2.14) mm, in group C (11.81 ± 2.20) mm, Statistical significance (P <0.05). (3) The excellent embryo rate was significantly higher in group A (47.23 ± 29.17)%, group B (59.95 ± 30.43)% and group C (65.66 ± 23.35)% than in group C (P <0.05). (4) The dosage of gonadotropin (Gn): The Gn in group A was not significantly different from that in group B (600.08 ± 291.21) U and group C (1776.36 ± 693.76) U, P <0.05. (5) The incidence of complications: A, B group ovarian hyperstimulation syndrome (OHSS) occurred, C group severe OHSS incidence was 2.18%. Conclusions The IVM regimen can effectively prevent OHSS during ovulation induction in PCOS patients and short-term Gn stimulation after IVM-assisted pregnancy regimen in order to obtain a clinical pregnancy rate similar to the traditional long-term regimen IVF. It is an economical, safe and effective method of pregnancy-assisted pregnancy in PCOS patients .