超长方案降调节对多囊卵巢综合症不孕患者行IVF结局的影响

目的：比较超长方案降调节和常规长方案降调节，在PCOS不孕症患者行IVF-ET治疗中对结局的影响。方法回顾性分析2008年4月到2013年1月间我院生殖中心收治行IVF的659例促排周期的PCOS患者，按降调节方案分为395例超长方案降调节组（A组）和264例常规长方案组（B组）。比较两组间临床和结局相关指标。结果⑴两组在年龄和不孕年限及基础性激素血值上比较均无差异。⑵IVF治疗中相关指标比较，两组HCG日E2水平、OHSS发生率差异无统计学意义；而A组在Gn总量（2509.87±1588.57）IU和（2173.82±827.10）IU、Gn天数（13.14±2.81）d和（11.13±2.24）d、HCG日内膜厚度（10.40±2.45）mm和（9.71±2.10）mm、获卵数（21.43±10.74）枚和（16.95±8.6）枚、全胚冷冻率（35.64%和20.55%）高于B组，差异有统计学意义；而在 HCG 日 LH（0.62±1.14）IU/L 和（0.85±0.68）IU/L、血清孕酮（P）水平（4.99±2.64）nmol/l 和（5.47±2.70）nmol/l、受精率（67.42%和70.34%）、优胚率（40.91%和43.01%）低于B组，差异有统计学意义。⑶两组移植后比较，两组移植胚胎数、多胎率、流产率、宫外孕率和全胚冷冻后冻融胚胎移植（freezing-embryo transfer，FET）临床妊娠率差异无统计学意义。 A组临床妊娠率（60.0%和56.84%）、种植率（43.47%和39.70%）均要高于B组，差异有统计学意义。结论超长方案降调节与常规长方案相比，能够很好的控制COH过程中LH的分泌，降低HCG日P水平的升高，增加HCG日子宫内膜的厚度，提高种植率和临床妊娠率。

Effect of super-long down-regulation protocol on the outcome of IVF-ET in the infertile patients with PCOS

Objective To compare the effect of super-long down-regulation protocol and conventional long down-regulation protocol on the outcome of IVF-ET in the infertile patients with PCOS. Methods A retrospective analysis was contained 659 in-fertile patients of PCOS to accept IVF-ET treatment between April 2008 to January 2013 in the center for reproductive medicine of Jiangxi maternal and child health hospital. They were divided to A group （395 cycles utilizing super-long down-regulation pro-tocol） and B group 264 cycles underwent conventional long down-regulation protocol）. Clinical indicators and outcomes were com-pared. Results Those were no significantly differences in age and infertility duration and the level of basic sexual hormone and the level of E2 on the HCG day and the OHSS occurred rate （P〉0.05）. In A group,the days and dose of Gn,endometrial thickness on the hCG day,the number of oocytes and whole embryo freezing rate were increased（P〈0.05）,but the levels of LH and P,fertility rate and good quality embryo rate were declined （P〈0.05）. The clinical pregnancy rate and implantation rate were significantly in-creased （P〈0.05）. Conclusion Compared with conventional long down-regulation protocol,super-long down-regulation protocol can control the level of LH and P in the COH process and enhance endometrial thickness on the hCG day and raise clinical preg-nancy rate and implantation rate in the infertile women with polycystic ovary syndrome.