中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
11期
833-837
,共5页
朱如如%肖仕全%赵军招%林佳%王佩玉%金聪聪%金武敏
硃如如%肖仕全%趙軍招%林佳%王珮玉%金聰聰%金武敏
주여여%초사전%조군초%림가%왕패옥%금총총%금무민
多囊卵巢综合征%不育,女(雌)性%促性腺素释放激素%卵母细胞%细胞,培养的%受精,体外
多囊卵巢綜閤徵%不育,女(雌)性%促性腺素釋放激素%卵母細胞%細胞,培養的%受精,體外
다낭란소종합정%불육,녀(자)성%촉성선소석방격소%란모세포%세포,배양적%수정,체외
Polycystic ovary syndrome%Infertility,female%Gonadotropin-releasing hormone%Oocytes%Cells,cultured%Fertilization in vitro
目的 比较多囊卵巢综合征(PCOS)不孕患者卵泡早期行促性腺激素释放激素激动剂(GnRH-a)降调节后,行未成熟卵体外培养(IVM)和体外受精(IVF)的治疗结局.方法 对2010年7月至2012年12月,在温州医科大学附属第一医院生殖医学中心行辅助生殖治疗的72例PCOS不孕患者的临床资料进行回顾性分析.在卵泡早期使用GnRH-a降调节后,再根据治疗方法不同分为IVM组36例和IVF组36例,比较两组实验室指标及临床结局.结果 (1)实验室指标:IVM组共获卵442个,IVF组共获卵560个.IVF组的卵母细胞成熟率为83.8％ (469/560),优质胚胎率为70.9％ (212/299),均高于IVM组的54.1％(239/442)和50.7％(73/144),分别比较,差异均有统计学意义(P ＜0.01);IVM组促性腺激素(Gn)使用时间为(2.8±1.5)d,Gn用量为(285±169)U;IVF组Gn使用时间为(11.0±1.0)d,Gn用量为(1499±165)U,分别比较,差异也有统计学意义(P＜0.01);IVM组的平均获卵数为(12.8±2.5)个、受精率为64.8％(155/239)、种植率为31％(23/74),IVF组分别为(15.6±3.1)个、65.5％(307/469)、31％(23/74),两组分别比较,差异均无统计学意义(P＞0.05).(2)临床结局:IVM组的临床妊娠率为44％(14/32),IVF组的临床妊娠率为55％(17/31),两组比较,差异无统计学意义(P＞0.05).IVF组的流产率为1/17,低于IVM组的1/14,但差异无统计学意义(P＞0.05).IVM组无一例卵巢过度刺激综合征(OHSS)发生,IVF组中重度OHSS发生率为31％ (11/36).结论 PCOS不孕患者卵泡早期GnRH-a降调节后行IVM和IVF治疗,均可获得比较满意的实验室和临床结局.IVM组的治疗周期短且可完全避免OHSS的发生,但流产率有升高趋势.IVF组的OHSS发生率较高,且促排卵药物用量增多.
目的 比較多囊卵巢綜閤徵(PCOS)不孕患者卵泡早期行促性腺激素釋放激素激動劑(GnRH-a)降調節後,行未成熟卵體外培養(IVM)和體外受精(IVF)的治療結跼.方法 對2010年7月至2012年12月,在溫州醫科大學附屬第一醫院生殖醫學中心行輔助生殖治療的72例PCOS不孕患者的臨床資料進行迴顧性分析.在卵泡早期使用GnRH-a降調節後,再根據治療方法不同分為IVM組36例和IVF組36例,比較兩組實驗室指標及臨床結跼.結果 (1)實驗室指標:IVM組共穫卵442箇,IVF組共穫卵560箇.IVF組的卵母細胞成熟率為83.8％ (469/560),優質胚胎率為70.9％ (212/299),均高于IVM組的54.1％(239/442)和50.7％(73/144),分彆比較,差異均有統計學意義(P ＜0.01);IVM組促性腺激素(Gn)使用時間為(2.8±1.5)d,Gn用量為(285±169)U;IVF組Gn使用時間為(11.0±1.0)d,Gn用量為(1499±165)U,分彆比較,差異也有統計學意義(P＜0.01);IVM組的平均穫卵數為(12.8±2.5)箇、受精率為64.8％(155/239)、種植率為31％(23/74),IVF組分彆為(15.6±3.1)箇、65.5％(307/469)、31％(23/74),兩組分彆比較,差異均無統計學意義(P＞0.05).(2)臨床結跼:IVM組的臨床妊娠率為44％(14/32),IVF組的臨床妊娠率為55％(17/31),兩組比較,差異無統計學意義(P＞0.05).IVF組的流產率為1/17,低于IVM組的1/14,但差異無統計學意義(P＞0.05).IVM組無一例卵巢過度刺激綜閤徵(OHSS)髮生,IVF組中重度OHSS髮生率為31％ (11/36).結論 PCOS不孕患者卵泡早期GnRH-a降調節後行IVM和IVF治療,均可穫得比較滿意的實驗室和臨床結跼.IVM組的治療週期短且可完全避免OHSS的髮生,但流產率有升高趨勢.IVF組的OHSS髮生率較高,且促排卵藥物用量增多.
목적 비교다낭란소종합정(PCOS)불잉환자란포조기행촉성선격소석방격소격동제(GnRH-a)강조절후,행미성숙란체외배양(IVM)화체외수정(IVF)적치료결국.방법 대2010년7월지2012년12월,재온주의과대학부속제일의원생식의학중심행보조생식치료적72례PCOS불잉환자적림상자료진행회고성분석.재란포조기사용GnRH-a강조절후,재근거치료방법불동분위IVM조36례화IVF조36례,비교량조실험실지표급림상결국.결과 (1)실험실지표:IVM조공획란442개,IVF조공획란560개.IVF조적란모세포성숙솔위83.8％ (469/560),우질배태솔위70.9％ (212/299),균고우IVM조적54.1％(239/442)화50.7％(73/144),분별비교,차이균유통계학의의(P ＜0.01);IVM조촉성선격소(Gn)사용시간위(2.8±1.5)d,Gn용량위(285±169)U;IVF조Gn사용시간위(11.0±1.0)d,Gn용량위(1499±165)U,분별비교,차이야유통계학의의(P＜0.01);IVM조적평균획란수위(12.8±2.5)개、수정솔위64.8％(155/239)、충식솔위31％(23/74),IVF조분별위(15.6±3.1)개、65.5％(307/469)、31％(23/74),량조분별비교,차이균무통계학의의(P＞0.05).(2)림상결국:IVM조적림상임신솔위44％(14/32),IVF조적림상임신솔위55％(17/31),량조비교,차이무통계학의의(P＞0.05).IVF조적유산솔위1/17,저우IVM조적1/14,단차이무통계학의의(P＞0.05).IVM조무일례란소과도자격종합정(OHSS)발생,IVF조중중도OHSS발생솔위31％ (11/36).결론 PCOS불잉환자란포조기GnRH-a강조절후행IVM화IVF치료,균가획득비교만의적실험실화림상결국.IVM조적치료주기단차가완전피면OHSS적발생,단유산솔유승고추세.IVF조적OHSS발생솔교고,차촉배란약물용량증다.
Objective To compare the outcomes of in-vitro maturation (IVM) and in-vitro fertilization (IVF) after early follicular phase gonadotropin-releasing hormone agonist (GnRH-a)down-regulation in infertile patients with polycystic ovary syndrome (PCOS).Methods From July 2010 to December 2012,72 infertile patients with PCOS undergoing assisted reproductive technology treatment in the Affiliated First Hospital of Wenzhou Medical University were enrolled in this study.The patients were divided into 2 groups,which were patients with early follieular phase down-regulation IVM (36 cases) at IVM group and early follicular phase down-regulation long protocol IVF (36 cases) at IVF group.The laboratory parameters and clinical outcomes were compared between two groups.Results (1) Lab parameters:a total of 442 oocytes were retrieved in group IVM,and 560 were in group IVF.The rate of mature oocytes of 83.8％ (469/560) and high-quality embryos of 70.9％ (212/299) at group IVF were significantly higher than that of group IVM [54.1％ (239/442) and 50.7％ (73/144),retrospectively,P ＜0.01].In group IVM,the average duration of gonadotropin (Gn) was (2.8 ± 1.5) days and the average dosage of Gn was (285 ± 169) U,which were significantly lower than (11.0 ± 1.0) days and (1499 ±165) U in group IVF (P ＜0.01).The mean number of oocytes retrieved 12.8 ± 2.5,fertilization rate of 64.8％ (155/239),and implantation rate of 31％ (23/74) in group IVM and 15.6 ±3.1,65.5％ (307/469),31％ (23/74) in group IVF,which did not reach statistical difference (P ＞0.05).(2) Clinical outcomes:the clinical pregnancy rate (17/31,55％) of IVF group was not significantly higher than that 44％ (14/32) at IVM group (P ＞ 0.05).The abortion rate was 1/17 at Group IVF and 1/14 in group IVM,which did not show statistical difference.Women at IVM group has no ovarian hyper-stimulation syndrome (OHSS) cycle,group IVF has 31％ (11/36) cycles presented moderate and severe OHSS.Conclusions Infertile patients with PCOS undergoing IVM and IVF treatment after early follicular phase GnRH-a down-regulation can get satisfactory laboratory and clinical outcome.In addition to short treatment cycle,IVM can also avoid the occurrence of OHSS completely,but it has a rising trend in the abortion rate.IVF has a high incidence of OHSS,meanwhile,it increases the dosage of gonadotropins.
