多囊卵巢综合征患者拮抗剂治疗中不同“扳机”方案对临床结局的影响

目的探讨对于多囊卵巢综合征（PCOS）患者拮抗剂方案中使用绒毛膜促性腺激素（HCG）、促性腺激素释放激素激动剂（GnRHa）和HCG+GnRHa三种不同的“扳机”方案对体外受精临床结局的影响。 方法回顾性分析2017年1月至2020年4月在我院生殖中心行体外授精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）拮抗剂方案治疗的PCOS患者,根据不同的“扳机”方案分为HCG组（406例）：HCG“扳机”;GnRHa组（222例）：GnRHa“扳机”;HGC+GnRHa组（226例）：HCG+GnRHa双“扳机”。比较三组患者获卵数、受精率、卵裂率、可移植胚胎数、优胚率及卵巢过度刺激综合征（OHSS）发生率。 结果三组之间的一般情况及卵裂率均无统计学差异（P＞0.05）。与HCG组相比,GnRHa组和GnRHa+HCG组获卵数［（21.71±6.84）、（21.68±7.97）个 vs （16.03±7.04）个］、受精率（68.32%、69.26% vs 65.15%）、可移植胚胎数［（7.88±3.36）、（8.09±3.21）个 vs （5.85±2.89）个］及优胚率（83.31%、83.27% vs 77.00%）明显升高,差异均有统计学意义（P均＜0.05）;GnRHa组与GnRHa+HCG组之间在获卵数、受精率、可移植胚胎数及优胚率方面比较,差异均无统计学意义（P均＞0.05）。与HCG组相比较,GnRHa组和HCG+GnRHa组的OHSS总发生率明显降低,差异有统计学意义（4.50%、4.87% vs 9.36%,P＜0.05）; GnRHa组与GnRHa+HCG组之间OHSS总发生率无统计学差异（P＞0.05）。 结论在拮抗剂方案治疗的PCOS患者中应用GnRHa联合HCG双“扳机”可以提高优质胚胎数,并且有助于降低OHSS风险。

Effect of different triggers on clinical outcomes in patients with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer with antagonist regimen

ObjectiveTo compare the effect of three different triggers (HCG, GnRHa, HCG+GnRHa) on in vitro fertilization outcome in patients with polycystic ovary syndrome (PCOS). MethodsA retrospective analysis was performed on 854 PCOS patients treated with antagonist regimen from January 2017 to April 2020. According to the trigger(s) used, the patients were divided into three groups: HCG group (406 cases, HCG trigger), GnRHa group (222 cases, GnRHa trigger), and HCG+GnRHa group (226 cases, dual triggers). The number of retrieved oocytes, fertilization rate, cleavage rate, transplantable embryos, high qualified embryo rate, and OHSS rate were compared among the three groups. ResultsThere were no statistically significant differences among the three groups in general characteristics and cleavage rate (P＞0.05). The number of retrieved oocytes [(21.71±6.84), (21.68±7.97) vs (16.03±7.04)], fertilization rate (68.32%, 69.26% vs 65.15%), transplantable embryos [(7.88±3.36), (8.09±3.21) vs (5.85±2.89)], and high qualified embryo rate (83.31%、83.27% vs 77.00%) in the GnRHa group and HCG+GnRHa group were significantly higher compared with those of the HCG group (P＜0.05), although there was no significant difference between the GnRHa group and HCG+GnRHa group (P＞0.05). The rates of OHSS in the GnRHa group and GnRHa+HCG group were significantly lower than that of the HCG group (4.50%, 4.87% vs 9.36%, P＜0.05), but there was no significant difference between the GnRHa group and HCG+GnRHa group (P＞0.05). ConclusionDual trigger can decrease the rate of severe OHSS and increase the number of high quality embryos.