多囊卵巢综合征患者促排卵中不同干预措施预防卵巢过度刺激的效果

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Abstract Objective: To investigate the effects of different intervention measures in preventing ovarian hyper-stimulation syndrome (OHSS) to polycystic ovary syndrome (PCOS) patients during ovarian stimulation of in vitro fertilization-embryo transfer (IVF-ET). Methods: A retrospective case-control study was conduced from Jan. 2011 to Dec. 2013. 124 cycles of PCOS patients with high risk of OHSS in the process of ovarian stimulation underwent IVF were divided into three groups: converted IVM group (n=43), when follicle diameter≤12 mm, stopped using gonadotropin (Gn), then injected human chorionic gonadotropin (hCG) 10 000 IU; hCG early injection group (n=41), went on stimulating, when there were more than one follicle diameter≥16 mm or more than three follicles diameter≥14 mm, injected hCG 4 000-6 500 IU; low-dose hCG group (n=37), went on stimulating, when there were more than one follicle diameter≥18 mm or 2-3 follicles diameter≥16 mm, injected hCG 3 000-4 000 IU. Laboratory results, clinical outcomes and the incidence of OHSS were compared among three groups. Results: In converted IVM group, the total dose of gonadotrophin was lower and stimulation length was shorter than those of other two groups. The rate of oocyte maturation, cleavage, high quality embryos in converted IVM group were significantly lower than other two groups (P<0.05). In hCG early injection group, numbers of follicle≥14 mm on the hCG injection day were less and rate of good quality embryo was lower than in low-dose hCG group, and there were no difference with the rest indicators between the two groups. There was no OHSS occurrence in converted IVM group, mild to moderate OHSS incidence in other two groups was no significant difference. There was no difference among three groups of clinical pregnancy rate and live birth rate. Conclusion: For the PCOS patients with high risk of OHSS during ovarian stimulation in IVF-ET, converted IVM from IVF could completely avoid OHSS. Otherwise both protocols of hCG early induction and low- dose hCG could avoid the occurrence of severe OHSS, and there was no distinct difference in preventing OHSS.

Key words： polycystic ovarian syndrome ovarian hyper-stimulation syndrome in vitro maturation low-dose human chorlonic gonadotrophin limited ovarian stimulation

Received: 10 July 2014

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	LIN Jia1
	ZHU Ruru2
	ZHAO Junzhao1
	WANG Peiyu1
	XIAO Shiquan1
	JIN Congcong1.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2015/V45/I7/519

[1] Practice Committee of American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome[J]. Fertil Steril, 2008, 90(5 Suppl): S188-193.
[2] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J]. Fertil Steril, 2004, 81(1): 19-25.
[3] 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.
[4] Nastri CO, Ferriani RA, Rocha IA, et a1. Ovarian hyperstimulation syndrome: pathophysiology and prevention[J]. J Assist Reprod Genet, 2010, 27(2-3): 121-128.
[7] Palomba S, Falbo A, Carrillo L, et al. Metformin reduces risk of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during gonadotropin-stimulated in vitro fertilization cycles: a randomized, controlled trial[J].Fertil Steril, 2011, 96(6): 1384-1390.
[5] Delvigne A. Symposium: Update on prediction and management of OHSS. Epidemiology of OHSS[J]. Reprod Biomed Online, 2009, 19(1): 8-13.
[6] Tummon I, Gavrilova-Jordan L, Allemand MC, et al. Polycystic ovaries and ovarian hyperstimulation syndrome: a systematic review[J]. Acta Obstet Gynecol Scand, 2005,84(7): 611-616.
[8] Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician[J]. Fertil Steril, 2010, 94(2): 389-400.
[9] De Vos M, Ortega-Hrepich C, Albuz FK, et al. Clinical outcome of non-hCG-primed oocyte in vitro maturation treatment in patients with polycystic ovaries and polycystic ovary syndrome[J]. Fertil Steril, 2011, 96(4): 860-864.
[10] Eftekhar M, Khalili MA, Aflatoonian A, et al. Successful pregnancy following a novel endometrial preparation in a PCOS patient undergoing IVM: a case report[J]. J Assist Reprod Genet, 2012, 29(4): 335-336.
[11] Shalom-Paz E, Holzer H, Son W, et al. PCOS patients can benefit from in vitro maturation (IVM) of oocytes[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 165(1): 53-56.
[12] Khalili MA, A Nottola S, Shahedi A, et al. Contribution of human oocyte architecture to success of in vitro maturation technology[J]. Iran J Reprod Med, 2013, 11(1): 1-10.
[13] Whelan JG 3rd, Vlahos NF. The ovarian hyperstimulation syndrome[J]. Fertil Steril, 2000, 73(5): 883-896.
[14] 陈霞, 赵军招, 王佩玉, 等. 不同剂量hCG对体外受精-胚胎移植结局的影响[J]. 温州医学院学报, 2012, 42(2): 154-156.
[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 cycles[J].
Reprod Biomed Online, 2007, 14(6): 682-685.
[16] Abdalla HI, Ah-Moye M, Brinsden P, et al. The effect of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an in vitro fertilization program[J]. Fertil Steril, 1987, 48(6): 958-963.
[17] 朱依敏, 高惠娟, 何荣环, 等. 限制性促排卵方案预防卵巢过度刺激综合征的探索性研究[J]. 中华妇产科杂志, 2006, 41(11), 740-744.
[18] El-Sheikh MM, Hussein M, Fouad S, et al. Limited ovarian stimulation (LOS), prevents the recurrence of severe forms of ovarian hyperstimulation syndrome in polycystic ovarian disease[J]. Eur J Obstet Gynecol Reprod Biol, 2001, 94(2): 245-249.
[19] Papageorgiou T, Guibert J, Goffinet F, et a1. Percentile curves of serum estradiol levels during controlled ovarian stimulation in 905 cycles stimulated with recombinant FSH show that high estradiol is not detrimental to IVF outcome [J]. Hum Reprod, 2002, 17(1l): 2846-2850.