多囊卵巢综合征患者超排卵过程中行卵泡抽吸的效果观察

目的 观察多囊卵巢综合征(PCOS)患者于行体外受精-胚胎移植(IVF-ET)的超排卵过程中抽吸卵泡的结局。方法 对13例首次行IVF-ET(对照周期)失败、发生卵巢过度刺激征(OHSS)的PCOS不孕患者,于再次行IVF—ET(卵泡抽吸周期)的超排卵过程中,在B超指引下经阴道对苴径9～10 mm的卵泡进行穿刺抽吸,保留直径9～10 mm卵泡≤10个。卵泡抽吸后继续进行超排卵方案。比较两个周期患者血清性激素水平变化及卵子发育等情况。结果 卵泡抽吸周期hCG注射日平均直径≥12 mm的卵泡数为(16±4)个,较对照周期(29±8)个明显减少,两个周期比较,差异有极显著性(P<0.001);卵泡抽吸周期平均血清雌二醇水平为(9899±1430)pmol/L,较对照周期(15 545±1767)pmoL/L明显降低,两个周期比较,差异有极显著性(P<0.001)。卵泡抽吸周期中,无患者发生中、重度OHSS;对照周期中,9例(9/13,69％)患者发生OHSS。卵子回收率、成熟率、受精率、卵裂率及胚胎种植率均显著高于对照周期。结论 于行IVF—ET的超排卵过程中,抽吸直径为9-10 mm的卵泡,能有效减少PCOS不孕患者hCG注射日的优势卵泡数目,降低血清雌二醇水平,减少中、重度OHSS的发生。

Outcome of follicular aspiration of selection phase in patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation

OBJECTIVE: To assess the effectiveness of follicular aspiration in selection phase of follicle growth of the patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS: Thirteen infertile patients with PCOS who previously failed IVF-ET associated with ovarian hyperstimulation syndrome (OHSS), served as control group, were asked to undergo new IVF cycles (follicular aspiration group) with ultrasound-guided transvaginal follicular aspirations in the selection phase (diameter 9 - 10 mm) of follicle growth, with a total of 13 cycles both. No more than 10 follicles were selected. Clinical and endocrinological parameters were monitored. RESULTS: In follicular aspiration group, the average number of follicle >or= 12 mm in diameter and serum estradiol level were 16 +/- 4 and (9899 +/- 1431) pmol/L respectively, which were significantly lower than 29 +/- 8 (P < 0.001) and (15,544 +/- 1767) pmol/L (P < 0.001) in control group. No moderate-severe OHSS occurred in follicular aspiration group, while 9 out of 13 (69%) occurred in control group. Oocyte retrieval rate, maturation rate, fertilization rate and cleavage rate in follicular aspiration group were greatly higher than those in control group. CONCLUSIONS: Follicular aspiration in selection phase of follicle growth associates with reduced dominant follicle numbers and estradiol level on the day of hCG injection and moderate-severe OHSS incidence in patients with PCOS undergoing IVF-ET.