多囊卵巢综合征患者控制性超促排卵下体内凝血相关指标的研究

目的观察控制性超促排卵(COH)下多囊卵巢综合征(PC()S)患者血浆同型半胱氨酸(homocysteine,HCY)、凝血因子Ⅷ(FⅧ)、凝血因子X(FX)和D-D二聚体与对照组有何差异,以及这些指标对移植成功率、妊娠结局有无影响。方法选择30例因排卵障碍需体外受精-胚胎移植(IVF-ET)助孕治疗的PCOS患者,同期选择67例因输卵管因素接受IVF治疗的患者为对照组,两组均采用标准长方案促排卵,于完全降调节日、注射人绒毛膜促性腺激素(HCG)日、取卵后第3天(移植日)清晨空腹采集静脉血,检测HCY、D-D二聚体、FⅢ和FX水平。结果两组间体重指数(BMI)、移植胚胎数、移植日内膜厚度、胚胎着床率以及临床妊娠率均无显著性差异,PC()S组平均年龄和正常受精率显著低于对照组(P<0.01),基础睾酮、基础雄烯二酮、LH/FSH比率、直径大于1 4 mm卵泡数、获卵数、优质胚胎数均显著高于对照组(P<0.05)。在完全降调节后,PCOS组除FX显著高于对照组(P<0.01),两组间HCY、FⅧ、D-D二聚体以及激素水平均无显著性差异;HCG日,PCOS组FX和雌二酵(E_2)水平显著高于对照组(P<0.05);移植日,PC()S组FⅧ水平显著低于对照组(P=0.012),FX和E_2水平显著高于对照组(P

Changes of coagulation and fibrinolytic indexes in women with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation

Objective： To compare plasma homocysteine （HCY）, coagulation factor VIII（FVIII）, coagulation factor X（FX）, D-D dimer and hormone parameters between women with polycystic ovary syndrome（PCOS） and non-PCOS, and evaluate impact of these indexes on successful embryo transfer and pregnancy outcomes. Methods： Of the 97 women, 30 patients with PCOS consisted of the study group, and 67 women of child-bearing age with normal menstrual cycle and endocrine function consisted of the control group. All participants underwent GnRH agonist long protocol. The plasma HCY, FVIII, FX,D-D dimer levels as well as hormone parameters were measured on the day of down-regulation,HCG priming and embryo transfer. Results： There was no significant difference in body mass index（BMI）, number of embryos transfer,endometrium thickness on the transfer day,implantation rate and clinical pregnancy rate between the study and control groups. Mean age and normal fertilization rate in the study group were significantly lower than those in control group, whereas basal testosterone, retrieved and superior embryos were significantly androstendione, LH/FSH ratio, number of oocytes higher. On day of down-regulation, there was no difference in plasma HCY,FVIII,I）-D dimer and hormone parameters between the two groups, except FX levels which was significantly higher in the study group（P〈0.01）. On HCG priming day,FX and estrogen levels were significantly higher in the study group. On embryo transfer day,FX and estrogen levels in the study group were higher than those in the control group, and FVIII levels were significantly lower, whereas FX and E2 levels were significantly higher in the study group. Conclusions： Our study showed that the number of oocytes retrieved in PCOS women was substantial, however, normal fertilization rate was still lower than that of non-PCOS women, and clinical pregnancy rate was tending to decrease in PCOS group. This unhealthy status was partly associated with hypercoagulable state in PCOS women in peri-implantation period, which probably leaded to poor microcirculation of endometrium,and an adverse effect on successful implantation and clinical pregnancy outcome.