PCOS不孕患者行IVF的治疗结局的研究
发布时间：2018-08-19 17:01
【摘要】：研究目的： 本研究旨在探讨PCOS患者与正常卵巢反应的不孕患者(输卵管因素不孕患者)促排卵后的临床特点以及行IVF-ET后的妊娠结局,同时探讨肥胖对于妊娠的影响。以期为PCOS患者的助孕治疗提供参考。 研究方法： 回顾分析了2009年1月-2014年1月在浙江大学附属妇产科医院生殖遗传中心行长方案控制性超促排卵后接受IVF-ET治疗的不孕患者。排除满足任一条件患者：1)年龄18岁或年龄34岁；2)BMI"f18.5kg/m2；3)女方有子宫内膜异位症、甲状腺功能减退症、高泌乳素血症、先天性肾上腺皮质增生症、染色体异常、既往卵巢手术史等影响生育的疾病；4)男方精液异常(包括少精症,弱精症或畸精症)。PCOS诊断根据Rotterdam标准(2003年)。对照组按年龄和BMI值以1：4的比例匹配选取因输卵管因素行IVF-ET不孕患者。筛选结果PCOS患者351例,管性不孕患者1404例。依据PCOS患者的BMI值将其分为正常体型组(18.5kg/m2"fBMI24kg/m2)和超重/肥胖组(BMI≥24kg/m2),比较两组妊娠结局。 研究结果： 相比于对照组,PCOS组促排卵期间Gn总量显著少于对照组,而PCOS患者hCG日血E2水平和获卵数显著高于对照组,其卵巢高反应风险和卵巢过度刺激发生率显著增加。PCOS组正常受精率低于对照组。但优胚率,胚胎移植个数,胚胎着床率无统计学上显著差异。PCOS组生化妊娠率,流产率显著高于对照组。而PCOS患者的临床妊娠率活产率显著低于对照组。超重和肥胖的PCOS患者相比正常体型组,其Gn用量和Gn使用时间增加,但取卵数和E2水平却较正常体型组下降。超重和肥胖的PCOS患者临床妊娠率降低,而流产率及活产率无明显改变。 研究结论： 1、PCOS患者对Gn刺激具有高反应性。 2、PCOS患者行IVF-ET后的正常受精率较输卵管因素不孕患者显著降低,但优质胚胎率无显著差异。 3、相比于输卵管因素不孕患者,PCOS患者行IVF后的妊娠结局提示其流产率显著增加,临床妊娠率和活产率显著降低。 4、超重和肥胖的PCOS患者行IVF对促性腺激素的需求增加,但敏感性降低,同时肥胖可能降低PCOS患者的临床妊娠率。
[Abstract]:Objective: to investigate the clinical characteristics and pregnancy outcome after ovulation induction in PCOS patients and infertile patients with normal ovarian reaction (oviduct factor infertility), and to explore the effect of obesity on pregnancy. In order to provide a reference for the treatment of pregnancy aid in patients with PCOS. Methods: from January 2009 to January 2014, the infertile patients who received IVF-ET treatment after controlled ovulation induced by the President of the Center for Reproductive Genetics, affiliated Obstetrics and Gynecology Hospital of Zhejiang University, were retrospectively analyzed. The female had endometriosis, hypothyroidism, hyperprolactinemia, congenital adrenocortical hyperplasia, and chromosomal abnormalities. Previous ovarian surgery and other diseases affecting fertility (4) semen abnormalities (including oligozoospermia, asthenospermia or teratospermia) .PCOS diagnosis according to Rotterdam criteria (2003). In the control group, IVF-ET infertility was performed according to age and BMI at 1:4. Results there were 351 cases of PCOS and 1404 cases of tubular infertility. According to the BMI value of PCOS patients, they were divided into 18.5kg/m2 "fBMI24kg/m2 group and overweight / obese group (BMI 鈮，
本文编号：2192275
[Abstract]:Objective: to investigate the clinical characteristics and pregnancy outcome after ovulation induction in PCOS patients and infertile patients with normal ovarian reaction (oviduct factor infertility), and to explore the effect of obesity on pregnancy. In order to provide a reference for the treatment of pregnancy aid in patients with PCOS. Methods: from January 2009 to January 2014, the infertile patients who received IVF-ET treatment after controlled ovulation induced by the President of the Center for Reproductive Genetics, affiliated Obstetrics and Gynecology Hospital of Zhejiang University, were retrospectively analyzed. The female had endometriosis, hypothyroidism, hyperprolactinemia, congenital adrenocortical hyperplasia, and chromosomal abnormalities. Previous ovarian surgery and other diseases affecting fertility (4) semen abnormalities (including oligozoospermia, asthenospermia or teratospermia) .PCOS diagnosis according to Rotterdam criteria (2003). In the control group, IVF-ET infertility was performed according to age and BMI at 1:4. Results there were 351 cases of PCOS and 1404 cases of tubular infertility. According to the BMI value of PCOS patients, they were divided into 18.5kg/m2 "fBMI24kg/m2 group and overweight / obese group (BMI 鈮，
本文编号：2192275
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