卵巢過度刺激對(duì)卵巢反應(yīng)性的影響
發(fā)布時(shí)間：2019-01-05 08:31
【摘要】：研究背景 體外授精-胚胎移植技術(shù)(IVF-ET)在全世界范圍內(nèi)被廣泛應(yīng)用以解決不孕不育問題。但同時(shí)它也會(huì)帶來許多并發(fā)癥,其中最為嚴(yán)重的醫(yī)源性并發(fā)癥即為卵巢過度刺激征(OHSS)。OHSS發(fā)生與否與不孕婦女的卵巢儲(chǔ)備功能,IVF-ET過程中促排卵方案的選擇,以及婦女在該促排卵方案下表現(xiàn)出的卵巢反應(yīng)性相關(guān)。本研究主要對(duì)具有OHSS高危因素的不孕婦女進(jìn)行研究,分析既往IVF史以及在促排卵過程中發(fā)生卵巢過度刺激對(duì)日后卵巢反應(yīng)性的影響。 對(duì)象與方法 選取于2010年1月1日至2014年12月31日之間因不孕于我院至少接受過2個(gè)周期IVF-ET助孕,且其中至少有一個(gè)周期出現(xiàn)OHSS高風(fēng)險(xiǎn)的患者,剔除不符合納入標(biāo)準(zhǔn)或符合排除標(biāo)準(zhǔn)的病人后,共203例患者,總計(jì)共425個(gè)IVF周期。所有患者均記錄了不孕原因；每個(gè)IVF-ET周期下患者的年齡、身高、體重,促排卵前患者的基礎(chǔ)血清激素值及竇卵泡數(shù),促排卵方案,注射HCG日的血清雌二醇值及HCG用量,取卵日期、獲卵總數(shù)及卵子的正常受精數(shù)；以及該周期是否發(fā)生OHSS及OHSS的嚴(yán)重程度。本研究即對(duì)上述指標(biāo)進(jìn)行統(tǒng)計(jì)分析以得出最終結(jié)論。 結(jié)果 所有總IVF周期數(shù)為2且具有卵巢過度刺激高危因素的不孕婦女,在第一個(gè)IVF周期下有47.8%的患者未發(fā)生OHSS高風(fēng)險(xiǎn),說明對(duì)具有OHSS高危因素的不孕婦女而言,在促排卵后發(fā)生卵巢過度刺激是一個(gè)高概率事件而非必然事件。 對(duì)第一周期未發(fā)生OHSS高風(fēng)險(xiǎn)而第二周期發(fā)生的患者研究發(fā)現(xiàn),第二周期下的Gn/N顯著高于第一周期,且兩周期間隔時(shí)間越短,Gn/N變化率越高,而其他指標(biāo)無差異。故認(rèn)為,既往IVF史能在短期內(nèi)增加卵巢反應(yīng)性,應(yīng)當(dāng)成為OHSS的一個(gè)高危因素。 在第一周期發(fā)生OHSS高風(fēng)險(xiǎn)的患者中,僅有37.1%的患者第二周期再次發(fā)生了OHSS高風(fēng)險(xiǎn)。兩類患者比較下發(fā)現(xiàn),第二周期未再次發(fā)生卵巢過度刺激,即卵巢反應(yīng)性有所減退的患者,與另一類患者相比第二周期下的基礎(chǔ)FSH水平升高,竇卵泡數(shù)減少,且兩次IVF周期的間隔時(shí)間較長(zhǎng)。故推斷：在發(fā)生卵巢過度刺激后,患者的卵巢儲(chǔ)備功能可能受到一定的影響而導(dǎo)致其卵巢反應(yīng)性下降。如患者兩次IVF周期的間隔時(shí)間較短,因既往IVF史所帶來的卵巢反應(yīng)性的短期增高可能會(huì)掩蓋發(fā)生卵巢過度刺激所導(dǎo)致的卵巢反應(yīng)性下降。 以所有總IVF周期數(shù)=2的患者其第一、二周期下的各項(xiàng)指標(biāo)作為資料,第二周期的Gn/N作為應(yīng)變量,其余因素作為變量,分別做定性和定量分析。多因素Logistics回歸的定性分析下證明：卵巢反應(yīng)性在既往IVF史作用下短期內(nèi)會(huì)有所上升,而卵巢過度刺激發(fā)生史,則是卵巢反應(yīng)性降低的高危因素。而AMIMA模型的定量分析下最終模型公式為(1-0.91*第一周期獲卵總數(shù)+0.81*第一周期促排卵用藥天數(shù)-0.10*第一周期HCG日E2值)*6.33(第二周期的Gn/N)=e. 對(duì)總周期數(shù)大于2個(gè)的患者進(jìn)行分析,通過分析各個(gè)IVF周期下Gn/N的變化情況發(fā)現(xiàn),在發(fā)生卵巢過度刺激之前,卵巢反應(yīng)性隨著IVF周期數(shù)的增加而上升,但發(fā)生卵巢過度刺激之后卵巢反應(yīng)性即有明顯下降。 結(jié)論 通過本研究得到以下結(jié)論： 1、既往IVF-ET史不會(huì)改變卵巢儲(chǔ)備功能,但能在短期內(nèi)增加卵巢反應(yīng)性,故應(yīng)當(dāng)成為發(fā)生OHSS的一個(gè)高危因素。 2、在IVF-ET周期的促排卵下如出現(xiàn)了卵巢過度刺激,可能造成卵巢儲(chǔ)備功能的損害,進(jìn)而影響日后的卵巢反應(yīng)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
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R714.8
本文編號(hào)：2401522
[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
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R714.8
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