【摘要】：研究目的： 本研究旨在探討PCOS患者與正常卵巢反應的不孕患者(輸卵管因素不孕患者)促排卵后的臨床特點以及行IVF-ET后的妊娠結局,同時探討肥胖對于妊娠的影響。以期為PCOS患者的助孕治療提供參考。 研究方法： 回顧分析了2009年1月-2014年1月在浙江大學附屬婦產(chǎn)科醫(yī)院生殖遺傳中心行長方案控制性超促排卵后接受IVF-ET治療的不孕患者。排除滿足任一條件患者：1)年齡18歲或年齡34歲；2)BMI"f18.5kg/m2；3)女方有子宮內(nèi)膜異位癥、甲狀腺功能減退癥、高泌乳素血癥、先天性腎上腺皮質(zhì)增生癥、染色體異常、既往卵巢手術史等影響生育的疾��；4)男方精液異常(包括少精癥,弱精癥或畸精癥)。PCOS診斷根據(jù)Rotterdam標準(2003年)。對照組按年齡和BMI值以1：4的比例匹配選取因輸卵管因素行IVF-ET不孕患者。篩選結果PCOS患者351例,管性不孕患者1404例。依據(jù)PCOS患者的BMI值將其分為正常體型組(18.5kg/m2"fBMI24kg/m2)和超重/肥胖組(BMI≥24kg/m2),比較兩組妊娠結局。 研究結果： 相比于對照組,PCOS組促排卵期間Gn總量顯著少于對照組,而PCOS患者hCG日血E2水平和獲卵數(shù)顯著高于對照組,其卵巢高反應風險和卵巢過度刺激發(fā)生率顯著增加。PCOS組正常受精率低于對照組。但優(yōu)胚率,胚胎移植個數(shù),胚胎著床率無統(tǒng)計學上顯著差異。PCOS組生化妊娠率,流產(chǎn)率顯著高于對照組。而PCOS患者的臨床妊娠率活產(chǎn)率顯著低于對照組。超重和肥胖的PCOS患者相比正常體型組,其Gn用量和Gn使用時間增加,但取卵數(shù)和E2水平卻較正常體型組下降。超重和肥胖的PCOS患者臨床妊娠率降低,而流產(chǎn)率及活產(chǎn)率無明顯改變。 研究結論： 1、PCOS患者對Gn刺激具有高反應性。 2、PCOS患者行IVF-ET后的正常受精率較輸卵管因素不孕患者顯著降低,但優(yōu)質(zhì)胚胎率無顯著差異。 3、相比于輸卵管因素不孕患者,PCOS患者行IVF后的妊娠結局提示其流產(chǎn)率顯著增加,臨床妊娠率和活產(chǎn)率顯著降低。 4、超重和肥胖的PCOS患者行IVF對促性腺激素的需求增加,但敏感性降低,同時肥胖可能降低PCOS患者的臨床妊娠率。
[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，

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