卵巢过度刺激综合征的影响因素及其对妊娠结局的影响

目的：通过回顾卵巢过度刺激综合征（OHSS）患者的情况，分析OHSS患者在控制性超促排卵（COH）过程中存在的危险因素及早发型和晚发型OHSS的差异。方法：选择2002年6月—2010年8月在本院行体外受精（IVF）治疗因中、重度OHSS住院患者36例（OHSS组），其中早发型OHSS 25例，晚发型OHSS 11例。选取因OHSS倾向行全胚冷冻或单胚移植而未发生OHSS的患者76例为高危组。另选取同期移植≥2个胚胎，与OHSS组基本情况相近，未发生OHSS者61例为对照组。记录注射人绒毛膜促性腺激素（hCG）日血清雌二醇（E2）水平、穿刺卵泡数及获卵数等。结果：①早发型OHSS患者hCG日E2水平高于晚发型（P＜0.05）。②OHSS组和高危组的hCG日E2值，卵泡数均高于对照组（P＜0.05）。③3组获卵数差异有统计学意义（P＜0.05），OHSS组的获卵数少于高危组（P＜0.05）。结论：①hCG日E2值升高可作为OHSS发生的参考指标。②卵泡数及获卵数是预测OHSS敏感的指标。③中、小卵泡较多时更易导致OHSS。

Risk Factors of Ovarian Hyperstimulation Syndrome and its Effect on Pregnancy Outcomes

Objective: To investigate the risk factors of ovarian hyperstimulation syndrome（OHSS） in those patients during the controlled ovarian hyperstimulation（ＣＯＨ） by a retrospective analysis, and compare further the early-onset OHSS and late-onset OHSS. Methods：Thirty six patients were hospitalized due to the moderate to severe OHSS from June 2002 to August 2010, including 25 early-onset OHSS patients and 11 late-onset OHSS patients. The high risk group included 76 patients who had the whole-embryo freezing or the one-embryo transfer due to their high risks of OHSS and did not suffer from OHSS. The control group included other 61 patients who had similar basic characteristics to the OHSS group，transferred more than 2 embryos and did not have OHSS. The level of serum estradiol was measured on the hCG injection day. The number of punctured follicle and the number of retrieved oocyte were counted. Results：① Patients with the early OHSS had higher E2 level on the hCG day than those patients with the late OHSS. ②The E2 levels on the hCG day and the numbers of oocyte in both the OHSS groups and the high risk group were higher than those in the control group. ③ There was significant difference in the number of retrieved oocyte among groups, while the OHSS group had significantly less retrieved oocyte than the high risk group. Conclusions：①The elevated level of E2 on the hCG day can be used as a auxiliary predictive factor for OHSS. ②The numbers of punctured follicle and harvested oocyte are sensitive factors for predicting OHSS. ③Multiple follicle development, especially many middle and small follicles, increases the risk of OHSS.