卵巢过度刺激对卵巢反应性的影响

发布时间：2019-01-05 08:31

【摘要】：研究背景体外授精-胚胎移植技术(IVF-ET)在全世界范围内被广泛应用以解决不孕不育问题。但同时它也会带来许多并发症,其中最为严重的医源性并发症即为卵巢过度刺激征(OHSS)。OHSS发生与否与不孕妇女的卵巢储备功能,IVF-ET过程中促排卵方案的选择,以及妇女在该促排卵方案下表现出的卵巢反应性相关。本研究主要对具有OHSS高危因素的不孕妇女进行研究,分析既往IVF史以及在促排卵过程中发生卵巢过度刺激对日后卵巢反应性的影响。对象与方法选取于2010年1月1日至2014年12月31日之间因不孕于我院至少接受过2个周期IVF-ET助孕,且其中至少有一个周期出现OHSS高风险的患者,剔除不符合纳入标准或符合排除标准的病人后,共203例患者,总计共425个IVF周期。所有患者均记录了不孕原因；每个IVF-ET周期下患者的年龄、身高、体重,促排卵前患者的基础血清激素值及窦卵泡数,促排卵方案,注射HCG日的血清雌二醇值及HCG用量,取卵日期、获卵总数及卵子的正常受精数；以及该周期是否发生OHSS及OHSS的严重程度。本研究即对上述指标进行统计分析以得出最终结论。结果所有总IVF周期数为2且具有卵巢过度刺激高危因素的不孕妇女,在第一个IVF周期下有47.8%的患者未发生OHSS高风险,说明对具有OHSS高危因素的不孕妇女而言,在促排卵后发生卵巢过度刺激是一个高概率事件而非必然事件。对第一周期未发生OHSS高风险而第二周期发生的患者研究发现,第二周期下的Gn/N显著高于第一周期,且两周期间隔时间越短,Gn/N变化率越高,而其他指标无差异。故认为,既往IVF史能在短期内增加卵巢反应性,应当成为OHSS的一个高危因素。在第一周期发生OHSS高风险的患者中,仅有37.1%的患者第二周期再次发生了OHSS高风险。两类患者比较下发现,第二周期未再次发生卵巢过度刺激,即卵巢反应性有所减退的患者,与另一类患者相比第二周期下的基础FSH水平升高,窦卵泡数减少,且两次IVF周期的间隔时间较长。故推断：在发生卵巢过度刺激后,患者的卵巢储备功能可能受到一定的影响而导致其卵巢反应性下降。如患者两次IVF周期的间隔时间较短,因既往IVF史所带来的卵巢反应性的短期增高可能会掩盖发生卵巢过度刺激所导致的卵巢反应性下降。以所有总IVF周期数=2的患者其第一、二周期下的各项指标作为资料,第二周期的Gn/N作为应变量,其余因素作为变量,分别做定性和定量分析。多因素Logistics回归的定性分析下证明：卵巢反应性在既往IVF史作用下短期内会有所上升,而卵巢过度刺激发生史,则是卵巢反应性降低的高危因素。而AMIMA模型的定量分析下最终模型公式为(1-0.91*第一周期获卵总数+0.81*第一周期促排卵用药天数-0.10*第一周期HCG日E2值)*6.33(第二周期的Gn/N)=e. 对总周期数大于2个的患者进行分析,通过分析各个IVF周期下Gn/N的变化情况发现,在发生卵巢过度刺激之前,卵巢反应性随着IVF周期数的增加而上升,但发生卵巢过度刺激之后卵巢反应性即有明显下降。结论通过本研究得到以下结论： 1、既往IVF-ET史不会改变卵巢储备功能,但能在短期内增加卵巢反应性,故应当成为发生OHSS的一个高危因素。 2、在IVF-ET周期的促排卵下如出现了卵巢过度刺激,可能造成卵巢储备功能的损害,进而影响日后的卵巢反应性。
[Abstract]:Study Background In vitro fertilization-embryo transfer (IVF-ET) is widely used worldwide to solve the problem of infertility The most serious iatrogenic complications are the ovarian hyperstimulation (OHSS), the ovarian reserve function of the infertility women, the selection of the ovulation-promoting scheme in the process of IVF-ET. and the ovarian response phase, which is shown by the woman in the ovulation-promoting scheme, This study mainly conducted a study of infertility women with high risk factors of OHSS, analyzed the history of previous IVF and the occurrence of ovarian hyperstimulation in the ovarian hyperstimulation process in the future. in response to The image and method were selected between January 1, 2010 and December 31, 2014 due to the sterility of at least 2 cycles of IVF-ET in our hospital, and at least one of the patients with high risk of OHSS at least one cycle, the elimination of non-compliance with inclusion criteria or compliance with the exclusion criteria A total of 425 patients with a total of 425 patients IVF cycles. The reason for infertility was documented for all patients; the age, height, body weight, the basal serum hormone value of the patient in each IVF-ET cycle, the basal serum hormone value of the patient before ovulation, the ovulation induction regimen, the serum estradiol value of the injection HCG day, and the amount of HCG, the egg date, the total number of eggs and the number of normal fertilization of the egg, and whether OHSS and OHSS occur in the cycle The study is to make a statistical analysis of the above-mentioned indexes. out of the The final conclusion. Results All of the total IVF cycles were 2 and had an ovarian hyperstimulation high risk factor of infertility women with a 47. 8% of patients in the first IVF cycle did not have an OHSS high risk, indicating a high risk of OHSS In the case of infertility women with a factor, ovarian hyperstimulation after ovulation is a high profile Rate events, not necessarily events. Patients with a second cycle that did not have an OHSS high risk for the first cycle found that Gn/ N in the second cycle was significantly higher than the first cycle, and the shorter the two-cycle interval, the Gn/ N rate of change The higher the previous IVF history can increase the ovarian response in a short period of time, it is considered that the previous IVF history can increase the ovarian response in a short period of time and should be A high risk factor for OHSS. In patients with high OHSS in the first cycle, only 37. 1% of the patients in the second week OHSS high risk occurred again in the period. The two patients found that the second cycle did not repeat the ovarian hyperstimulation, i.e., the patient with decreased ovarian response, the basal FSH level in the second cycle was increased compared with the other type of patient, and the number of follicle-stimulating follicles decreased, and the two patients The interval between the subIVF cycles is longer. Therefore, it is concluded that the ovarian reserve function of the patient may be subject to a certain degree of ovarian hyperstimulation The decrease in ovarian response due to the impact. If the interval between the two IVF cycles of the patient is short, the short-term increase in the ovarian response due to previous IVF history may mask the occurrence of ovarian hyperreactivity The response of the ovarian response caused by the stimulation was decreased. The indices of the first and second cycles of all patients with total IVF cycle number = 2 were used as data, and the Gn/ N of the second period was used as the corresponding variable and the remaining factors The qualitative and quantitative analysis of the multivariate logistic regression demonstrated that the ovarian response increased in the short term in the short period of the previous IVF history, and a history of ovarian hyperstimulation. The final model formula for AMMA model is (1-0.91 * The first cycle of the first cycle is + 0.81 * The first period of ovulation is + 0.81 * The first cycle HCG day E2 value) * 6. 33 (Gn/ N of the second cycle) = e. Analysis was performed on patients with a total cycle number of more than 2, and by analyzing the changes in Gn/ N in each IVF cycle, the ovarian response increased with the increase in the number of IVF cycles before the ovarian hyperstimulation, but the ovarian failure occurred over After the stimulation, the ovarian response is clear. The conclusion is as follows: 1. The previous IVF-ET history does not change the ovarian reserve function, but the eggs can be increased in the short term nest reactivity should be a high risk factor in the occurrence of OHSS. 2. Ovarian hyperstimulation occurs under the stimulation of the IVF-ET cycle, which may
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R714.8

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