CAJ | 학술논문

目的比较多囊卵巢综合征(PCOS)患者与非PCOS患者行未刺激未成熟卵母细胞体外成熟(IVM)方案与改行IVM方案的临床结局.方法将2008年1月至2013年12月在温州医科大学附属第一医院行IVM治疗的591个新鲜周期分成4组,PCOS未刺激IVM组为PCOS患者行未刺激周期IVM方案,共240个周期;PC OS改行IVM组为PCOS患者在常规体外受精-胚胎移植(IVF-ET)促排卵周期中因卵泡多或发育较慢而改行IVM方案,共153个周期;非PCOS未刺激IVM组为非PCOS患者行未刺激周期IVM方案组,共103个周期;非PCOS改行IVM组为非PCOS患者改行IVM方案,共95个周期.采用多元线性回归分析和二元logistic回归分析评价各项基础指标、是否为PCOS及IVM方案选择对实验室结果和临床结局的影响.结果获卵数与PCOS呈正相关[偏回归系数(B)=3.37,P＜0.01],卵母细胞成熟率与取卵前注射hCG呈正相关(B=0.05,P=O.010),优质胚胎率与PCOS、改行IVM呈正相关(B=0.08,P=0.010; B=0.09,P=0.001),胚胎种植率与PCOS、改行IVM呈正相关(B=0.07,P=0.010;B=0.10,P＜0.01).PCOS使hCG阳性(即hCG＞10 U/L)率和临床妊娠率升高(OR=1.636,95％CI为1.113～2.204,P＜0.05;OR=1.507,95％CI为1.041～ 2.240,P＜0.05);改行IVM方案使hCG阳性率和临床妊娠率升高(OR=1.861,95％CI为1.307～ 2.649,P＜0.05;OR=1.881,95％CI为1.312～2.696,P＜0.05)并使自然流产率降低(OR=0.490,95％CI为0.245～ 0.978,P＜0.05);而是否为PCOS和IVM方案选择对多胎妊娠率和异位妊娠发生率无显著影响(P＞0.05).结论 PCOS和改行IVM方案可提高优质胚胎率、胚胎种植率、hCG阳性率和临床妊娠率,改行IVM方案可降低自然流产率.PCOS患者比非PCOS患者更适合行IVM治疗;不论是否为PCOS患者,采用改行IVM方案比采用未刺激周期IVM方案可以获得更好的妊娠结局.
목적 비교다낭란소종합정(PCOS)환자여비PCOS환자행미자격미성숙란모세포체외성숙(IVM)방안여개행IVM방안적림상결국.방법 장2008년1월지2013년12월재온주의과대학부속제일의원행IVM치료적591개신선주기분성4조,PCOS미자격IVM조위PCOS환자행미자격주기IVM방안,공240개주기;PC OS개행IVM조위PCOS환자재상규체외수정-배태이식(IVF-ET)촉배란주기중인란포다혹발육교만이개행IVM방안,공153개주기;비PCOS미자격IVM조위비PCOS환자행미자격주기IVM방안조,공103개주기;비PCOS개행IVM조위비PCOS환자개행IVM방안,공95개주기.채용다원선성회귀분석화이원logistic회귀분석평개각항기출지표、시부위PCOS급IVM방안선택대실험실결과화림상결국적영향.결과 획란수여PCOS정정상관[편회귀계수(B)=3.37,P＜0.01],란모세포성숙솔여취란전주사hCG정정상관(B=0.05,P=O.010),우질배태솔여PCOS、개행IVM정정상관(B=0.08,P=0.010; B=0.09,P=0.001),배태충식솔여PCOS、개행IVM정정상관(B=0.07,P=0.010;B=0.10,P＜0.01).PCOS사hCG양성(즉hCG＞10 U/L)솔화림상임신솔승고(OR=1.636,95％CI위1.113～2.204,P＜0.05;OR=1.507,95％CI위1.041～ 2.240,P＜0.05);개행IVM방안사hCG양성솔화림상임신솔승고(OR=1.861,95％CI위1.307～ 2.649,P＜0.05;OR=1.881,95％CI위1.312～2.696,P＜0.05)병사자연유산솔강저(OR=0.490,95％CI위0.245～ 0.978,P＜0.05);이시부위PCOS화IVM방안선택대다태임신솔화이위임신발생솔무현저영향(P＞0.05).결론 PCOS화개행IVM방안가제고우질배태솔、배태충식솔、hCG양성솔화림상임신솔,개행IVM방안가강저자연유산솔.PCOS환자비비PCOS환자경괄합행IVM치료;불론시부위PCOS환자,채용개행IVM방안비채용미자격주기IVM방안가이획득경호적임신결국.
Objective To compare the laboratory and clinical results between unstimulated in vitro maturation (IVM) and IVM converted from in vitro fertilization (IVF) in polycystic ovarian syndrome (PCOS) and non-PCOS patients.Methods We divided 591 IVM cycles in the First Affiliated Hospital of Wenzhou Medical Univesity from Jan.2008 to Dec.2013 into 4 groups:group A1B1,PCOS patients underwent unstimulated IVM protocol,240 cycles; group A1B2,PCOS patients underwent IVM converted from conventional stimulated IVF protocol,153 cycles; group A2B1,non-PCOS patients underwent unstimutlated IVM protocol,103 cycles; group A2B2,non-PCOS patient underwent IVM converted from conventional stimulated IVF protocol,95 cycles.Multiple linear regression method and binary logistic regression method were used to assess the influence of PCOS and protocols for IVM on laboratory and clinical outcomes.Results The mean number of oocytes retrieved was positively related with PCOS [partial regression coefficient (B)=3.37,P＜0.01].The maturation rate of oocytes was positively related with hCG-prime prior to oocyte aspiration (B=0.05,P=0.010).High-quality embryo rate was positively related with PCOS and IVM converted from IVF (B=0.08,P=0.010; B=0.09,P=0.001),as well as implantation rate related with them (B=0.07,P=0.010; B=0.10,P＜0.01).PCOS and IVM converted from IVF improved hCG positive (hCG＞10 U/L) rate (OR=1.636,95％CI:1.113-2.204,P＜0.05; OR=1.861,95％CI:1.307-2.649,P＜0.05) and the clinical pregnancy rate (OR=1.507,95％CI:1.041-2.240,P＜0.05; OR=1.881,95％CI:1.312-2.696,P＜0.05).IVM converted from IVF protocol decreased the spontaneous abortion rate (OR=0.490,95％CI:0.245-0.978,P＜0.05).Multiple gestation rate and ectopic pregnancy rate were not affected by PCOS condition and protocol used (P＞0.05).Conclusions PCOS and IVM converted from IVF protocol improved the high-quality embryo rate,implantation rate,hCG positive rate and clinical pregnancy rate.IVM converted from IVF protocol reduced the spontaneous abortion rate.PCOS patients may be more suitable for the IVM treatment.No matter PCOS or non-PCOS patients,IVM converted from IVF protocol had better pregnancy outcome than that of unstimulated cycle.