CAJ | 학술논문

目的：探讨多囊卵巢综合征（PCOS）患者在体外受精-胚胎移植（IVF-ET）周期促排卵中运用不同干预措施预防卵巢过度刺激综合征（OHSS）的效果。方法：采用回顾性病例对照研究，将2011年1月至2013年12月本院124例行IVF-ET治疗并在超促排卵过程中出现OHSS倾向的PCOS患者分为3组：改行卵母细胞体外培养（IVM）组（n=46），卵泡直径均≤12 mm时，停促性腺激素（Gn），注射人绒毛膜促性腺激素（hCG）10000 IU；hCG提前组（n=41），继续促排卵，当有1个卵泡直径≥16 mm或至少3个卵泡直径≥14 mm时，注射hCG 4000～6500 IU；hCG减量组（n=37），继续促排卵，当至少有1个卵泡的直径≥18 mm或2～3个卵泡的直径≥16 mm时，注射hCG 3000～4000 IU。比较各组实验室结果、临床结局及OHSS发生率。结果：改行IVM组总Gn用量及Gn天数显著少于其余2组，该组卵子成熟率、卵裂率、优质胚胎率均低于其余2组，差异有统计学意义（P＜0.05）。hCG提前组的hCG注射日≥14 mm卵泡数、优质胚胎率低于hCG减量组，其余各指标2组差异无统计学意义（P＜0.05）。改行IVM组无OHSS发生，另2组轻、中度OHSS发生率差异无统计学意义（P＞0.05）。3组临床妊娠率、胎儿活产率差异无统计学意义（P＜0.05）。结论：对于有OHSS倾向的PCOS患者，在IVF-ET周期促排卵过程中，可以采用改行IVM方案完全避免OHSS发生，而提前注射hCG与减量hCG方案均能避免重度OHSS的发生，在预防OHSS发生方面无明显差异。
목적：탐토다낭란소종합정（PCOS）환자재체외수정-배태이식（IVF-ET）주기촉배란중운용불동간예조시예방란소과도자격종합정（OHSS）적효과。방법：채용회고성병례대조연구，장2011년1월지2013년12월본원124례행IVF-ET치료병재초촉배란과정중출현OHSS경향적PCOS환자분위3조：개행란모세포체외배양（IVM）조（n=46），란포직경균≤12 mm시，정촉성선격소（Gn），주사인융모막촉성선격소（hCG）10000 IU；hCG제전조（n=41），계속촉배란，당유1개란포직경≥16 mm혹지소3개란포직경≥14 mm시，주사hCG 4000～6500 IU；hCG감량조（n=37），계속촉배란，당지소유1개란포적직경≥18 mm혹2～3개란포적직경≥16 mm시，주사hCG 3000～4000 IU。비교각조실험실결과、림상결국급OHSS발생솔。결과：개행IVM조총Gn용량급Gn천수현저소우기여2조，해조란자성숙솔、란렬솔、우질배태솔균저우기여2조，차이유통계학의의（P＜0.05）。hCG제전조적hCG주사일≥14 mm란포수、우질배태솔저우hCG감량조，기여각지표2조차이무통계학의의（P＜0.05）。개행IVM조무OHSS발생，령2조경、중도OHSS발생솔차이무통계학의의（P＞0.05）。3조림상임신솔、태인활산솔차이무통계학의의（P＜0.05）。결론：대우유OHSS경향적PCOS환자，재IVF-ET주기촉배란과정중，가이채용개행IVM방안완전피면OHSS발생，이제전주사hCG여감량hCG방안균능피면중도OHSS적발생，재예방OHSS발생방면무명현차이。
Objective: To investigate the effects of different intervention measures in preventing ovarian hyper-stimulation syndrome (OHSS) to polycystic ovary syndrome (PCOS) patients during ovarian stimulation of in vitro fertilization-embryo transfer (IVF-ET).Methods: A retrospective case-control study was conduced from Jan. 2011 to Dec. 2013. 124 cycles of PCOS patients with high risk of OHSS in the process of ovarian stimula-tion underwent IVF were divided into three groups: converted IVM group (n=43), when follicle diameter≤12 mm, stopped using gonadotropin (Gn), then injected human chorionic gonadotropin (hCG) 10 000 IU; hCG early injection group (n=41), went on stimulating, when there were more than one follicle diameter≥16 mm or more than three follicles diameter≥14 mm, injected hCG 4 000-6 500 IU; low-dose hCG group (n=37), went on stimulating, when there were more than one follicle diameter≥18 mm or 2-3 follicles diameter≥16 mm, injected hCG 3 000-4 000 IU. Laboratory results, clinical outcomes and the incidence of OHSS were compared among three groups.Results: In converted IVM group, the total dose of gonadotrophin was lower and stimula-tion length was shorter than those of other two groups. The rate of oocyte maturation, cleavage, high quality embryos in converted IVM group were signiifcantly lower than other two groups (P<0.05). In hCG early injec-tion group, numbers of follicle≥14 mm on the hCG injection day were less and rate of good quality embryo was lower than in low-dose hCG group, and there were no difference with the rest indicators between the two groups. There was no OHSS occurrence in converted IVM group, mild to moderate OHSS incidence in other two groups was no signiifcant difference. There was no difference among three groups of clinical pregnancy rate and live birth rate.Conclusion: For the PCOS patients with high risk of OHSS during ovarian stimulation in IVF-ET, con-verted IVM from IVF could completely avoid OHSS. Otherwise both protocols of hCG early induction and low- dose hCG could avoid the occurrence of severe OHSS, and there was no distinct difference in preventing OHSS.