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The decision for GnRH antagonist protocol in PCOS patients:with or without oral contraceptive pill ;pretreatment Y

By 杨硕, 陈新娜, 李蓉, 王海燕, 王颖 and 李红真

Abstract

目的:通过对比是否进行口服避孕药预治疗的患者的临床结局,探索在多囊卵巢综合征(PCOS)患者拮抗剂促排卵方案采用口服避孕药预治疗的利弊。方法前瞻性队列分析2011年6月至12月在北京大学第三医院妇产科生殖医学中心采取GnRH拮抗剂固定方案进行控制性促排卵及IVF/ICSI助孕的PCOS患者的临床资料(n=239),按进入周期前是否口服避孕药进行预治疗分为两组[未口服OCP组(NOCP),n=116;口服OCP组(OCP),n=123]。对患者的一般资料及临床结局进行比较。结果两组患者年龄、不孕年限及基础FSH、E2及T水平均无统计学差异(P>0.05)。NOCP组患者体重指数(BMI)及基础LH均显著低于OCP组[BMI(22.7±3.5)kg/m2 vs.(23.7±3.7)kg/m2;LH(5.9±4.3)IU/L vs.(8.4±5.5)IU/L,P<0.05],而进周期当月月经第2天(即启动Gn前)的血LH水平两组比较无统计学意义(P>0.05)。两组Gn天数及Gn用量均无统计学差异[Gn天数(11±1.6)d vs.(10±1.6)d;Gn用量(1474±423)IU vs.(1517±462)IU, P>0.05]。NOCP组患者获卵数、优质胚胎数均显著高于OCP(获卵数20±10 vs.16±8;可移植胚胎数10±6 vs.8±5;优质胚胎数9±6 vs.7±5)。NOCP组患者临床妊娠率、胚胎种植率及持续妊娠率均显著高于OCP组[临床妊娠率50.5%(46/91)vs.33.3%(36/108);胚胎种植率29.6%(59/199) vs.19.6%(44/225);持续妊娠率49.5%(45/91)vs.27.8%(30/108),P<0.05]。在对相关因素进行多元回归分析后,发现影响妊娠率的因素为口服避孕药及患者年龄。两组患者中、重度OHSS发生率无统计学差异,OCP组全胚冻存取消移植率(为预防OHSS)显著低于NOCP组[11.4%(14/123) vs.21.6%(25/116),P<0.05]。结论口服避孕药的预治疗可能对PCOS患者拮抗剂方案的临床结局有负面影响。Objective To assess the impact of oral contraceptive pill (OCP) pretreatment in controlled ovarian stimulation for in vitro fertilization (IVF) using gonadotropin releasing hormone (GnRH) antagonist among polycystic ovarian syndrome (PCOS) patients. Methods This is a predictive cohort study. There were 239 infertile patients with PCOS accepted IVF/ICSI treatment with GnRH antagonist fixed protocol. The patients were divided into two groups depending on using OCP pretreatment or not (without OCP pretreatment, NOCP group, n=116; OCP pretreatment, OCP group, n=123). To compare the general characteristics and clinical outcomes of the two groups. Results There were no significantly difference between the two groups refer to age, infertility time, and basal FSH, E2, T(P>0.05). The BMI and basal LH were significantly lower in NOCP group[BMI (22.7±3.5)kg/m2 vs. (23.7±3.7)kg/m2;LH (5.9±4.3)IU/L vs. (8.4±5.5)IU/L, P<0.05], but the LH before using gonadotropin was no significantly difference (P>0.05). The duration and dose of gonadotropin were no significantly difference, duration of Gn (11±1.6)d vs. (10±1.6)d;Gn dose (1 474±423)IU vs. (1 517±462)IU, P>0.05. The number of oocyte retrieved and good quality embryo were significantly higher in NOCP group (oocyte retrieved 20±10 vs. 16±8;good quality embryo 9±6 vs. 7±5, P<0.05). The clinical pregnancy rate, embryo implantation rate and ongoing pregnancy rate were significantly higher in NOCP group, clinical pregnancy rate 50.5%(46/91) vs. 33.3%(36/108); embryo implantation rate 29.6% (59/199) vs. 19.6%(44/225); ongoing pregnancy rate 49.5%(45/91) vs. 27.8% (30/108), P<0.05. The Regression analysis showed that accepted OCP pretreatment and the patients’ age could affect the clinical outcome. The incidence of moderate/severe OHSS was no significant difference between the two groups, the incidence of cancelled embryo transfer (for preventing OHSS) was significantly lower in OCP group [11.4%(14/123) vs. 21.6%(25/116), P<0.05]. Conclusion Pretreatment with OCP in PCOS patients might have negative effect for clinical outcomes.0101825-182

Topics: 排卵诱导, 避孕药,口服, 多囊卵巢综合征, 促性腺素释放激素拮抗剂, Ovulation induction, Contraceptives,oral, Polycystic ovary syndrome, GnRH antagonist
Publisher: 中华临床医师杂志电子版
Year: 2014
DOI identifier: 10.3877/cma.j.issn.1674-0785.2014.10.006
OAI identifier: oai:localhost:20.500.11897/106343
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