多囊卵巢综合征合并胰岛素抵抗对体外受精-胚胎移植临床结局的影响

目的分析多囊卵巢综合征(PCOS)患者进行体外受精-胚胎移植(IVF-ET)时,胰岛素抵抗与临床结局的关系。方法选择PCOS患者181例为实验组(A组),将合并胰岛素抵抗的分为A1组,不合并胰岛素抵抗的分为A2组;月经周期规则且无胰岛素抵抗的输卵管性不孕(均为双侧输卵管梗阻)患者138例作为对照组(B组)。三组患者均采用经典长方案进行体外受精-胚胎移植(IVF-ET),比较各组间年龄、体重指数、AMH、性激素水平、Gn天数、Gn用量、HCG日内膜厚度、HCG日E2值、HCG日P值、获卵数、优质胚胎数、ET数、妊娠率、着床率、流产率与PCOS胰岛素抵抗的关系。结果三组间基本情况、Gn天数、HCG日内膜厚度、HCG日E2、HCG日P值优质胚胎个数、HCG日内膜厚度、ET个数差异无统计学意义(P>0.05);B组与A组比较妊娠率、着床率、流产率差异无统计学意义(P>0.05),但妊娠率、着床率呈递减趋势,流产率呈增高趋势;A1组与A2组妊娠率、着床率、流产率差异无统计学意义(P>0.05),A1组与B组比较妊娠率,着床率减低,差异有统计学意义(P<0.05),两组流产率差异无统计学意义(P>0.05),但呈增高趋势。结论PCOS人群IVF-ET的临床结局偏差,合并胰岛素抵抗成为降低辅助生殖助孕结局的重要影响因素。

Clinical outcomes analysis of insulin-resistant IVF-ET patients with polycystic ovary syndrome

Objective:To analyze the relationship between insulin resistance and clinical outcomes in IVF-ET patients with(PCOS).Methods:181 cases of PCOS patients,whose infertility were related to bilateral tubal obstruction with regular menstrual cycle and no insulin resistance were selected as the experimental group A.138 cases were selected as the control group B,Group A was divided into group A1,with insulin resistance and group A2,without insulin resistance.All patients in the three groups use classic long protocol.The relationship between age,body mass index,AMH,sex hormone level,Gn days,Gn dosage,number of ovum obtained,number of high-quality embryos,ET number,pregnancy rate,implantation rate,abortion rate and insulin resistance was compared among the groups.Results:The basic LH level,AMH level,BMI,less dosage of Gn and number of ovum obtained of group A were significantly higher than those of group B,and the differences were statistically significant(P<0.05).Number of ovum obtained,E2 level on HCG day in A1 and A2 showed no statistically significant difference(P>0.05).There was no statistically significant difference in pregnancy rate,implantation rate and abortion rate among group B,groupA2 and group A1(P>0.05),but the pregnancy rate and implantation rate showed a decreasing trend and the abortion rate showed an increasing trend.Pregnancy rate and implantation rate of group B were higher than those of group A1,and the difference was statistically significant(P<0.05).There was no statistically significant in abortion rate of two groups(P>0.05),but it showed a decreasing trend.Conclusion:The deviation of IVF-ET clinical outcome and insulin in PCOS population are important factors to reduce the outcome of assisted reproductive assisted pregnancy.