垂体降调节天数对PCOS患者体外受精胚胎移植结局的影响

目的探讨多囊卵巢综合征患者IVF-ET中促性腺激素（Gn）用药前最佳降调节天数。方法将2006年3月～2008年8月在本中心接受体外受精-胚胎移植（IVF-ET）和卵泡浆内单精子显微注射（ICSI）的多囊卵巢综合征患者146例,按照Gn用药前垂体降调节天数的不同分为3组：A组≤10d,B组11～14d,C组≥15d。回顾性分析比较不同垂体降调节天数对获卵数、优质胚胎率、临床妊娠率、OHSS发生率的影响。结果3组患者年龄、基础内分泌水平（E2、FSH、LH、P）、hCG注射日E2、LH、P水平及内膜厚度没有明显差异（P〉0.05）;C组Gn用药天数、剂量明显高于A组、B组,（P〈0.05）;3组获卵数、OHSS发生率没有明显差异（P〉0.05）;受精率、优质胚胎率、A组与C组、B组与C组之间之间没有明显差异（P〉0.05）,但B组与A组差异明显（P〈0.05）。临床妊娠率B组高于C组,C组高于A组但三者没有统计学意义。结论Gn用药前垂体降调节天数对妊娠结局有一定的影响,降调节天数≥15d时需增大Gn用量及天数,降调节天数11～14d时可得到较高的受精率和优质胚胎率。

The influence of the days of down regulation before using Gn to the pregnancy outcomes of PCOS.

Objective： The aim of the study was to investigate the optimal days of down regulation before using Gn to PCOS. Methods： According to the days of down regulation before using Gn, 146 PCOS women who accepted the IVF/ICSI were divided into three groups： group A （≤10d）, group B （11 -14d） and group C （≥15d）. Reviewed to study the eggs＇amount, the high quality embryo＇rate, the clinical pregnancy rate and the OHSS occured rate. Analyze the relativity of days of down regulaion with them. Resuits： The patients＇age, the level of basic E2, FSH, LH, P, the level of E2, LH, P and the thickness of endometrium on the hCG day have no obviously differences in the three groups （ P 〉 0. 05 ）. The days and dose of Gn between group A and B have no obviously differences （ P 〉0. 05） ; but group C were higher than the two groups （ P 〈0. 05）. There are no obviously differences on the eggs＇ amount and the OHSS occurred rate in the three groups. And the high quality embryo rate, fertilization rate and the clinical pregnaney rate have no obviously differences between A and C, B and C （ P 〉 0.05 ）. But there are obvious differences between B and A （ P 〈 0. 05 ）. Conclusion ： The days of down regulaion before using Gn may affect the pregnancy outcomes. If the days of down regulaion were beyond 15d, we should increase the dose and days of Gn. We can obtain more high quality embryo and higher clinical pregnancy rate when the down regulaion days between lid and 14d.