PCOS与非PCOS卵巢高反应患者的助孕结局比较

目的比较PCOS与非PCOS卵巢高反应患者的助孕结局。方法回顾性分析我院2016年1月至2018年12月行IVF/ICSI-ET助孕的卵巢高反应患者的病历资料(共1236个周期),根据是否合并PCOS分为PCOS组(309个周期)和非PCOS组(927个周期)。比较两组患者的一般资料、促排卵情况、实验室指标及妊娠结局。结果两组患者的一般资料比较均无显著性差异(P>0.05);PCOS组患者体重指数(BMI)、抗苗勒管激素(AMH)、基础LH(bLH)水平和基础窦卵泡数(AFC)均显著高于非PCOS组(P<0.05)。两组患者促排卵方案所占比例、Gn天数、Gn总量、HCG日E2水平比较均无显著性差异(P>0.05);PCOS组获卵数显著多于非PCOS组(P<0.01)。两组行IVF的情况比较,PCOS组受精率显著高于非PCOS组,2PN受精率和优胚率则显著低于非PCOS组(P均<0.05),2PN卵裂率比较无显著性差异(P>0.05);两组行ICSI情况比较,受精率、2PN卵裂率两组间无显著性差异(P>0.05),PCOS组2PN受精率和优胚率显著高于非PCOS组(P<0.05);两组的总优胚率比较无显著性差异(P>0.05)。两组患者鲜胚移植的临床妊娠率、种植率、活产率、流产率和异位妊娠率比较均无显著性差异(P均>0.05)。PCOS组鲜胚移植中重度卵巢过度刺激综合征(OHSS)的发生率显著高于非PCOS组(P<0.05),两组行全胚冷冻中重度OHSS的发生率比较无显著性差异(P>0.05)。结论PCOS卵巢高反应患者IVF的优胚率显著低于非PCOS高反应患者,ICSI的优胚率则显著高于非PCOS高反应患者,但二者总的优胚率、新鲜周期的临床妊娠率和活产率无明显差异。PCOS高反应患者较非PCOS高反应患者行新鲜胚胎移植后中重度OHSS的发生率显著增加,故临床上对PCOS高反应患者行鲜胚移植时应该慎重,冻融胚胎移植可能是更好的选择。

Comparison of pregnancy outcomes between PCOS and non-PCOS patients with ovarian high response

Objective:To compare the pregnancy outcomes between PCOS and non-PCOS patients with high ovarian response.Methods:The data of patients(1236 cycles)with ovarian high response who conceived IVF/ICSI in our hospital from January 2016 to December 2018 were retrospectively analyzed.According to with or without PCOS,the cycles were divided into PCOS group(n=309)and non-PCOS group(n=927).The general information,ovulation induction,laboratory indicators and pregnancy outcomes of the two groups of patients were compared.Results:There were no significant differences in general information(P>0.05).The BMI,AMH levels,basic LH levels and antral follicle count(AFC)in PCOS group were significantly higher than those in the non-PCOS group(P<0.05).There were no significant differences in Gn days,total dosage of Gn,and the level of E2 on HCG day between the two groups(P>0.05).The numbers of oocytes retrieved in PCOS group were significantly higher than that of the non-PCOS group(P<0.05).Comparing the IVF outcomes between the two groups,the fertilization rate in the PCOS group was significantly higher than that in the non-PCOS group(P<0.01),and the 2PN fertilization rate and good-quality embryos rate in PCOS group were significantly lower than that in the non-PCOS group(P<0.05),but the 2PN cleavage rate were similar in the two groups(P>0.05).Comparing the ICSI outcomes between the two groups,no significant difference was found in fertilization rate and the 2PN cleavage rate(P>0.05);the 2PN fertilization rate and good-quality embryos rate in the PCOS group were significantly higher than that in the non-PCOS group(P<0.05);and the total good-quality embryo rate were similar between the two groups(P>0.05).There were no significant differences in the clinical pregnancy rate,implantation rate,live birth rate,abortion rate,and ectopic pregnancy rate of fresh embryo transfer cycles between the two groups(P>0.05).The incidence of moderate and severe ovarian hyperstimulation syndrome(OHSS)rate of fresh embryo transfer cycles in the PCOS group was significantly higher than that in the non-PCOS group(P<0.05).And the incidence of moderate and severe OHSS in all-frozen embryos cycles were similar in both two groups(P>0.05).Conclusions:The good-quality embryo rate of IVF treatment in PCOS patients with high ovarian response is significantly lower than that in non-PCOS patients,but the good-quality embryo rate of ICSI treatment in PCOS patients is significantly higher than non-PCOS patients.However,there were no significant differences in total good-quality embryo rate,the clinical pregnancy rate and live birth rate in fresh embryo transfer cycles between the two groups.In addition,the incidences of moderate and severe OHSS in fresh embryo transfer cycles in PCOS patients are significantly higher than that in non-PCOS patients.Therefore,it should be prudent to perform fresh embryo transfer in PCOS patients with high responder,and frozen-thawed embryo transfer may be a better choice.