目的:探讨多囊卵巢综合征(PCOS)患者初次进行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕时最佳方案的选择。方法:≤45岁初次行IVF/ICSI-ET助孕的PCOS患者1 407名,按照超长方案(A组)、长方案(B组)、短方案(C组)和拮抗剂方案(D组)分成4组,比较各组患者基本临床特征、控制性超促排卵(COH)特征、重度卵巢过度刺激综合征(OHSS)发生率及临床结局。结果:除A组年龄偏大外,各组体质量指数(BMI)、基础血清性激素水平相当;A组与B组促性腺激素(Gn)使用天数、剂量高于C组和D组,C组与D组h CG注射日血清LH、E2水平明显高于A组和B组,h CG注射日内膜厚度A组与B组明显高于C组和D组,A组临床妊娠率、持续妊娠率和活产率明显高于其他各组(P<0.05)。重度OHSS、异位妊娠率、早期流产率各组间无统计学差异(P>0.05)。多元因素回归显示IVF方案(OR=0.813,95%CI=0.667~0.991)、h CG注射日内膜厚度(OR=1.262,95%CI=1.148~1.388)和空腹血糖水平(OR=1.395,95%CI=1.021~1.905)可能影响PCOS患者临床妊娠率(P<0.05)。结论:PCOS患者在初次尝试IVF助孕时,选择超长方案可获得更佳的子宫内膜容受性,提高临床妊娠率、持续妊娠率以及活产率,且不增加重度OHSS发生率。不足之处是Gn应用时间较长、剂量较大,可能增加临床治疗费用。 Objective: To explore the optimal protocol for IVF / ICSI-ET assisted fertilization in patients with polycystic ovary syndrome (PCOS) who underwent IVF / ESG for the first time. Methods: A total of 1 407 PCOS patients undergoing IVF / ICSI-ET were enrolled in this study. The patients were randomly divided into long-term treatment (group A), long-term treatment (group B), short-term treatment ) Were divided into 4 groups. The basic clinical characteristics, controlled ovulation hyperstimulation (COH) characteristics, incidence of severe ovarian hyperstimulation syndrome (OHSS) and clinical outcome were compared between the groups. Results: The body mass index (BMI) and basal serum sex hormone levels were similar in all groups except for the age of group A. The days of gonadotropin (Gn) in groups A and B were higher than those in groups C and D Compared with group A and group B, the levels of LH and E2 in group D and group CG were significantly higher than those in group A and group B. The intima thickness was significantly higher in group A and group B than group C and group D on day h CG injection. The clinical pregnancy rate, Rate and live birth rate were significantly higher than other groups (P <0.05). Severe OHSS, ectopic pregnancy rate, early abortion rate between the groups showed no significant difference (P> 0.05). Multivariate regression analysis showed that the intimal thickness (OR = 1.262, 95% CI = 1.148-1.388) and fasting blood glucose (h = 0.395, 95% CI = % CI = 1.021 ~ 1.905) may affect the clinical pregnancy rate in patients with PCOS (P <0.05). CONCLUSIONS: PCOS patients at the first attempt of IVF assisted pregnancy may have better endometrial receptivity by selecting the longer regimen and improve their clinical pregnancy rate, continuous pregnancy rate and live birth rate without increasing the incidence of severe OHSS. The downside is that Gn uses a longer time, a larger dose, may increase the cost of clinical treatment.