IVF-ET促排卵中卵巢过度刺激综合征高危患者的干预策略

目的：探讨体外受精-胚胎移植（IVF-ET）促排卵中针对卵巢过度刺激综合征（OHSS）高危患者所采取的3种预防策略的有效性。方法：回顾性分析2015年1月至2016年7月在温州医科大学附属第一医院生殖医学中心行IVF促排卵5～7 d后呈现卵巢高反应的OHSS高危患者178例的临床资料，根据所采用的干预策略不同分为3组。A组（低剂量HCG扳机组，n=95）：继续给予促排卵用药，密切超声监测卵泡发育，直至卵泡成熟，给予较低剂量的HCG扳机；B组（小卵泡抽吸减灭组，n=23）：超声引导下经阴道穿刺术减灭直径≤12 mm 的卵泡，之后继续促排卵用药至HCG扳机；C组（未成熟卵体外培养IVM组，n=60）：停止继续促排卵用药，超声引导下经阴道穿刺术抽吸所有可见小卵泡，将卵泡液中卵丘-卵母细胞复合体分离后进行体外培养成熟。比较各组实验室结果、临床妊娠结局和OHSS发生率。结果：3组优质胚胎率、移植周期临床妊娠率以及活婴分娩率差异无统计学意义（P＞0.05）。3组均无重度OHSS发生。轻、中度OHSS的发生率A组为50.53%，B组为34.78%，均显著高于C组（0%）（P＜0.05），A组和B组间差异无统计学意义（P＞0.05）。结论：对于IVF-ET促排卵中OHSS高危患者，采用低剂量HCG扳机、小卵泡抽吸减灭和未成熟卵体外培养均能完全避免发生重度OHSS，有效减少轻、中度OHSS的发生，同时3种干预策略都能带来较理想的妊娠结局。

The effect of different strategies to prevent ovarian hyperstimulation syndrome in high-risk patients undergoing ovarian stimulation protocol in IVF

Objective: To investigate the effectiveness of three strategies to prevent ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing IVF cycles. Methods: Patients in group A (n=95) received decreased dose of HCG trigger. Patients in group B (n=23) were subjected to transvaginal aspiration of small follicles. Patients in group C (n=60) were subjected to in-vitro maturation (IVM). Results: No significant differences were detected in the rate of high-quality embryos, clinical pregnancy rate per-transfer and live birth delivery rate per transfer among 3 groups (P>0.05). No severe OHSS was observed in all patients. The incidence of mild-moderate OHSS was significantly higher in group A (50.53%) and B (34.78%), while none was observed in group C (0%). Conclusion: Transformation into IVM resulted in completely absence of OHSS. Follicle aspiration and decreased HCG trigger could both avoid severe OHSS and remarkably reduce the occurrence of mild-moderate OHSS. OHSS high risk patients could have ideal pregnancy outcomes with the above-mentioned three strategies.