IVF-ET促排卵中卵巢过度刺激综合征高危患者的干预策略

doi:10.3969/j.issn.2095-9400.2019.01.002

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摘要目的：探讨体外受精-胚胎移植（IVF-ET）促排卵中针对卵巢过度刺激综合征（OHSS）高危患者所采取的3种预防策略的有效性。方法：回顾性分析2015年1月至2016年7月在温州医科大学附属第一医院生殖医学中心行IVF促排卵5～7 d后呈现卵巢高反应的OHSS高危患者178例的临床资料，根据所采用的干预策略不同分为3组。A组（低剂量HCG扳机组，n=95）：继续给予促排卵用药，密切超声监测卵泡发育，直至卵泡成熟，给予较低剂量的HCG扳机；B组（小卵泡抽吸减灭组，n=23）：超声引导下经阴道穿刺术减灭直径≤12 mm 的卵泡，之后继续促排卵用药至HCG扳机；C组（未成熟卵体外培养IVM组，n=60）：停止继续促排卵用药，超声引导下经阴道穿刺术抽吸所有可见小卵泡，将卵泡液中卵丘-卵母细胞复合体分离后进行体外培养成熟。比较各组实验室结果、临床妊娠结局和OHSS发生率。结果：3组优质胚胎率、移植周期临床妊娠率以及活婴分娩率差异无统计学意义（P＞0.05）。3组均无重度OHSS发生。轻、中度OHSS的发生率A组为50.53%，B组为34.78%，均显著高于C组（0%）（P＜0.05），A组和B组间差异无统计学意义（P＞0.05）。结论：对于IVF-ET促排卵中OHSS高危患者，采用低剂量HCG扳机、小卵泡抽吸减灭和未成熟卵体外培养均能完全避免发生重度OHSS，有效减少轻、中度OHSS的发生，同时3种干预策略都能带来较理想的妊娠结局。

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	滕依丽
	余蓉
	徐芝慧
	潘洁雪
	杨海燕
	黄学锋

关键词 ：卵巢高反应, 卵巢过度刺激综合征, 体外受精-胚胎移植

Abstract：Objective: To investigate the effectiveness of three strategies to prevent ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing IVF cycles. Methods: Patients in group A (n=95) received decreased dose of HCG trigger. Patients in group B (n=23) were subjected to transvaginal aspiration of small follicles. Patients in group C (n=60) were subjected to in-vitro maturation (IVM). Results: No significant differences were detected in the rate of high-quality embryos, clinical pregnancy rate per-transfer and live birth delivery rate per transfer among 3 groups (P>0.05). No severe OHSS was observed in all patients. The incidence of mild-moderate OHSS was significantly higher in group A (50.53%) and B (34.78%), while none was observed in group C (0%). Conclusion: Transformation into IVM resulted in completely absence of OHSS. Follicle aspiration and decreased HCG trigger could both avoid severe OHSS and remarkably reduce the occurrence of mild-moderate OHSS. OHSS high risk patients could have ideal pregnancy outcomes with the above-mentioned three strategies.

Key words： high ovarian response ovarian hyper-stimulation syndrome in vitro fertilization-embryo transfer

基金资助:浙江省医药卫生科技计划项目（2017KY462）；国家自然科学基金青年基金资助项目（81801411）。

通讯作者: 黄学锋，主任医师，Email：695281769@qq.com。

作者简介: 滕依丽（1978-），女，浙江永嘉人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2019.01.002 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I1/6

[1] SZABA G, AROKSZALLASI A, POCSI D, et al. Pathophysiology and current clinical approach of ovarian hyper-stimulation syndrome[J]. Orvosi Hetilap, 2018, 159(34): 1390-1398.
[2] DELVIGNE A. Symposium: update on prediction and management of OHSS: epidemiology of OHSS[J]. Reprod Biomed Online, 2009, 19(1): 8-13.
[3] NAMAVAR J B, PARSANEZHAD M E, SHOMALI Z, et al.
Ovarian hyperstimulation syndrome: A narrative review of its pathophysiology, risk factors, prevention, classification, and management[J]. Iran J Med Sci, 2018, 43(3): 248-260.
[4] CHAN W S, DIXON M E. The "ART" of thromboembolism: a review of assisted reproductive technology and thromboembolic complications[J]. Thromb Res, 2008, 121 (6): 713-726.
[5] SZKODZIAK P R, CZUCZWAR P, WRONA W, et al. Ascites Index-a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study[J]. Ginekologia Polska, 2018, 89(4): 182-188.
[6] MACKLON N S, FAUSER B C. Gonadotropin therapy for the treatment of anovulation and for ovarian hyperstimulation for IVF[J]. Mol Cell Endocrinol, 2002, 186(2): 159-161.
[7] 余蓉, 林佳, 赵军招, 等. 未成熟卵母细胞体外成熟与常规体外受精-胚胎移植技术治疗多囊卵巢综合征不孕的疗效比较[J]. 中华妇产科杂志, 2012, 47(4): 250-254.
[8] DEPA-MARTYNOW M, JEDRZEJCZAK P, PAWELCZYK L. Pronuclear scoring as a predictor of embryo quality in in vitro fertilization program[J]. Folia Histochem Cytobiol, 2007, 45 Suppl 1: S85-S89.
[9] GOLAN A,WEISSMAN A. Symposium: Update on prediction and management of OHSS. A modern classification of OHSS[J]. Reprod Biomed Online, 2009, 19(1): 28-32.
[10] WORMER K C, JANGDA A A, EISAYED F A, et al. Is thromboprophylaxis cost effective in ovarian hyperstimulation syndrome: A systematic review and cost analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 224(5): 117-124.
[11] CORBETT S, SHMORGUN D, CLAMAN P. The prevention of ovarian hyperstimulation syndrome[J]. J Obstet Gynaecol Can, 2014, 36(11): 1024-1033.
[12] AJONUMA L C. Is vascular endothelilagrowthfactor (VEGF) the main mediatorion ovarian hyperstimulation syndrome (OHSS)?[J]. Med Hypotheses, 2008, 70(60): 1174-1178.
[13] VLAHOS N F, GREGORIOU O. Prevention and management of ovarian hyperstimulation syndrome[J]. Ann N Y Acad Sci, 2006, 1092(12): 247-264.
[14] TSOUMPOU I, MUGLU J, GELBAYA T A, et al. Update on prediction and management of OHSS. Optimal dose of HCG for final oocyte maturation in IVF cycles: absence of evidence?[J]. Reprod Biomed, 2009, 19(1): 52-58.
[15] NARGUND G, HUTCHISON L, SCARAMUZZI R, et al. Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cy-cles[J]. Reprod Biomed Online, 2007, 14(6): 682-685.
[16] KAHNBERG A, ENSKOG A, BRANNSTROM M, et al. Prediction of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization[J]. Acta Obstet Gynecol Scand, 2009, 88(12): 1373-1381.
[17] SCHRӧDER A K, SCHӧPPER B, ALHASANI S, et al. Unilateral follicular aspiration and in-vitro maturation before contralateral oocyte retrieval: a method to prevent ovarian hyperstimulation syndrome[J]. Eur J Obstet Gynecol Reprod Biol, 2003, 110(2): 186-189.
[18] EGBASE P E, SHARHAN M A, GRUDZINSKAS J G. Early unilateral follicular aspiration compared with coasting for the prevention of severe ovarian hyperstimulation syndrome: a prospective randomized study[J]. Hum Reprod, 1999, 14(6): 1421-1425.
[19] COLACURCI N, ZULLO F, DE F P, et al. In vitro fertilization following laparoscopic ovarian diathermy in patients with polycystic ovarian syndrome[J]. Acta Obstet Gynecol Scand, 1997, 76(6): 555-558.
[20] OYAWOYE O A, CHANDER B, HUNTER J, et al. Prevention of ovarian hyperstimulation syndrome by early aspiration of small follicles in hyper-responsive patients with polycystic ovaries during assisted reproductive treatment cy-cles[J]. Med Gen Med, 2005, 7(3): 60.
[21] 池海虹, 黄朝霞, 程静, 等. 小卵泡穿刺术在控制性促排卵中应用的效果观察[J]. 温州医科大学学报, 2014, 44(9): 657-659.
[22] CHIAN R C, BUCKETT W M, TULANDI T, et al. Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome[J]. Hum Reprod, 2000, 15(1): 165-170.
[23] BUCKETT W, CHIAN R C, TAN S L. Can we eliminate severe ovarian hyperstimulation syndrome? Not completely[J]. Hum Reprod, 2005, 20(8): 2367-2368.
[24] 王佩玉, 赵军招, 金聪聪, 等. IVM技术在PCOS与非PCOS患者促排卵与未刺激周期中的临床应用比较[J]. 中华妇产科杂志, 2014, 49(12): 903-908.
[25] MIKKELSEN A L, SMITH S, LINDENBERG S. Possible factors affecting the development of oocytes in in-vitro mat-uration[J]. Hum Reprod, 2000, 15 Suppl 5: 11-17.
[26] BUCKETT W M, CHIAN R C, HOLZER H, et al. Obstetric outcomes and congenital abnormalities after in vitro maturation, in vitro fertilization, and intracytoplasmic sperm injec-tion[J]. Obstet Gynecol, 2007, 110(4): 885-891.
[27] HATIRNAZ S, ATA B, SAYNUR HATIRNAZ E, et al. Oocyte in vitro maturation: A sytematic review[J]. Turk J Obstet Gynecol, 2018, 15(2): 112-125.
[28] WALLS M L, HART R J. In vitro maturation[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 7(s): 1521-1534.