不同促排卵方案在多囊卵巢综合征不孕患者中的疗效分析.pdf

该【不同促排卵方案在多囊卵巢综合征不孕患者中的疗效分析 】是由【学习一点】上传分享，文档一共【7】页，该文档可以免费在线阅读，需要了解更多关于【不同促排卵方案在多囊卵巢综合征不孕患者中的疗效分析 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。:..·332·??????2023?3??32??3?DOI:.1004‐·????·???????σ???????????????????Н,??,??*(???,?????????????430000)【??】???????????????σ(PPOS)、????σ????σ????????(PCOS)??????IVF‐ET?????????、σ?PPOS???????????3?2022??1?2019???????。?σ????σ????PCOS???????,?390?。ο?????σ????PPOS?σ?(?=43)、????σ?(?=177)????σ?(?=170),б?3????????、??????(COS)????、???????????????。??3????????б????????(?>)。?????б?:?????σ??б,PPOS?σ?????σ??Gn???、Gn????????,HCG?LH、E2?P???????(?<);PPOS?σ?????σ?б?,HCG?LH?E2??????(?<),?????????????(?>)。???????б?:PPOS?σ????、OHSS???、??????????????σ?????σ?(?<);PPOS?σ??????σ??????????????????σ?PPOS?,)<?(?σ?????σ?????????(?>);PPOS?σ????????????σ?????σ?(?<)。????б?:3??????????(?>);??????????,???σ???????????????σ?(?<),???????????,3??????????????(?>)。????PCOS??,?б??????σ????σ,PPOS?σ????,OHSS????,??????????????????σ????σ,??????????????,??????σ???,?????????????????????。??Ч????????,????????,?????????????????????Ч???。【???】???σ;???????????σ;????σ;???????;????‐????;【?????】【?????】A??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????‐???,????????,???????*??????????????????????????,???????????????????????????????,?????430000【????????】?????????:Toinvestigatetheclinicaleffectsofprogestin‐primedovarianstimulation(PPOS)protocol,antagonistprotocol,ultralongprotocolonIVF‐ETininfertilewomenwithpolycysticovarysyndrome(PCOS).???????:hefirstIVF‐(COS)protocols,thepatientsweredividedintothreegroups:PPOSprotocolgroup(?=【????】2022‐08‐06;【????】2022‐10‐18【????】????????(81771618,81971356)【????】??Н,?,?К???,?????,??????.(*????):..??????2023?3??32??3?·333·44),antagonistprotocolgroup(?=177)andultralongprotocolgroup(?=170).Thegeneralbasicdata,COSprocessdata,paredamongthethreegroups.???????:parable(?>).Thetotaldaysanddoseofgonadotropin(Gn)usedinPPOSprotocolgroupandultralongprotocolgroupweresignificantlyhigher,andthelevelsofLH,E2andprogesteroneonHCGdayweresignificantlylowerthanthoseinantagonistprotocolgroup(?<).Comparedwiththeultralongprotocolgroup,thelevelsofLHandE2onHCGdayinthePPOSprotocolgroupweresignificantlyhigher(?<),andtherewasnosignificantdifferenceinotherindicators(?>).Thenumberofoocytesretrieved,incidenceofOHSSandcumulativepregnancyrateinPPOSprotocolgroupweresignificantlylowerthanthoseintheantagonistprotocolgroupandultralongprotocolgroupgroups(?<).TheutilizationrateofoocyteinPPOSprotocolgroupandantagonistprotocolgroupwassignificantlyhigherthanthatintheultralongprotocolgroup(?<),buttherewasnosignificantdifferencebetweenPPOSprotocolgroupandantagonistprotocolgroup(?>).ThecleavagerateofPPOSprotocolgroupwassignificantlyhigherthanthatofantagonistprotocolgroupandultralongprotocolgroup(?<).Therewasnosignificantdifferenceintheabortionrateamongthethreegroups(?>).Inthefreshembryotransfercycle,thepersistentpregnancyrateoftheultralongprotocolgroupwassignificantlyhigherthanthatoftheantagonistprotocolgroup(?<),whileinthefrozen‐thawedembryotransfercycle,therewasnosignificantdifferenceinthepersistentpregnancyrateamongthethreegroups(?>).???????????:ForpatientswithPCOS,,theembryolaboratorydataaresimilartothoseoftheantagonistprotocolandtendtobebetterthanthatoftheultralongprotocol,andthereisnosignificantdifferenceinthepersistentpregnancyrateamongthethreegroupsinthefrozen‐,ithassomelimitations,thereforeitisstillnecessarytofurtherobserveandverifythisconclusioninprospectivelargerandomizedcontrolledtrial.????????:Ultralongprotocol;Progestin‐primedovarianstimulationprotocol;Antagonistprotocol;Polycysticovarysyndrome;IVF‐ET(??????????2023,32(03):332‐338)????????,]7]?????????σ?、????????)PCOS(???????????θ、?????????????????????????(PPOS)?σ????σ?Б??????,???????4%~21%[1],???,Ч???2019?1??2022?3????PCOS?????????????????????????IVF‐ET???PCOS???30%[2],PCOS?????????????????????,???PPOS?σ、GnRH??????????????????,???????σ?GnRH??????σ3????????????????,?????????????σ??PCOS??????????。???,????????????????????????????????,???、??????、??[3‐5]???????。IVF/ICSI‐ET??PCOS??、????[6]?????????????????,??????,??2019?1??2022?3??????????(GnRH)????GnRH???????????PPOS?σ、????σ????:..·334·??????2023?3??32??3?σ????PCOS???????。?3~4h????IVF??,???16~18h?????:(1)??????????PCOS?????????,????3?、?5???6????,????????(?)???、??????????????。??????????、???????:?????????.3???????????、?3?????2?????????????????????????Ⅰ~Ⅳ?,??Ⅲ?????????;(2)?1??IVF??;(3)??????Ф????????,Ⅰ??Ⅱ???Ф[8]????;(4)?PPOS??????;???????????σ????、σ??Gardner?σ???;(5)???,]9]????????,????????3????,?????????????。?????B????Ф???????。????:(1)????????????;4.?????????:ET???????(2)???????、??????;(3)???????οЧ??????????,???10~12d???????,?????????????????β‐HCG,?>10U/L????HCG??;??;(3)PCOS????????,?????????28~30d???????,??????????、????????28????;????????????)4(;???????、??????????。??????。???390???,ο?????σ?????、????PPOS?σ?(43?)、????σ?(177?)??1.????:??、?????(BMI)、?????σ?(170?)。???(AMH)、??????(AFC)、?????????、?(bFSH、bLH、bE2)、????、????。1.????σ:(1)PPOS?σ:??????2.??????(COS)????:Gn???、2????????????(MPA,??,??Gn???、HCG????E2、LH、P?。?)10mg/d??HCG?,???????????3.???????:???、???????、????????????????(HMG,??MⅡ??、???、???、?????、????б?,ν???)125~300U/d,?2~3d???????OHSS???。???????=???????????,???????????????;?/???×100%;MⅡ??=MⅡ??/???×(2)????σ:??????2???????100%;???=????/???????×HMG??????(FSH,???,????),??100%;???=??????/????×100%;?????≥14mm?E2??>734~1101pmol/L?????=?????/??????×100%;???????GnRH?????????(??????б?=?????/?????×100%;?,?????,??)??HCG?,?OHSS???=OHSS???/???×100%。2~3d???????????,???????4.??????:?????、???、???????????;(3)???σ:??????2??。?????=[(???????-???????????GnRH???(Н?,????)?????)/??????]×100%;???=?,28~30d?????GnRH?????????/???????×100%;????,?????28~30d?????????=???????/?????×100%。B?,???????、?????Gn,Gn?????????????σ,???????????Gn??,????????????。????HCG???。????????±???(珔?±?)??,??б??2.???IVF:???????1?????≥???????????,??б?????????????20mm?2??(?????????????;????,?mm18≥????????????)??????????(HCG,????)8000~[?(?25,?75)]??,??б??????????‐??????10000U???????????????б??,???????????h36~34,???;??????????。??????????????,??(%)??,??б???2???FisherExact?χ:..??????2023?3??32??3?·335·?,??б?????PPOS???,?????????=α????。???α?σ?,?<??????????。???,????σ?177???,???σ?170???。3??????、BMI、AMH、AFC、?????????、????、?????????????、??????б????(?>)(?1)。????????б?[(?±?),%]?????????????????bFSH/(U/L)bLH/(U/L)bE2/(pmol/L)PPOS?σ?±±±±±%儋0篌い枛梃潩è 膊:贩????σ?±±±±±%儋0篌い枛梃潩è 膊:贩???σ?±±±±±%苘儋0篌い枛梃潩è 膊:贩2????????BMI/(kg/m)AMH/(ng/ml)AFC????????PPOS?σ?±±±(23/43)(20/43)%妹览档0篌梃挝父:贩????σ?±±±(119/177)(58/177)%妹览档0篌梃挝父:贩???σ?±±±(117/170)(53/170)%妹览档0篌梃挝父:贩????,?σ??????????2E?LH?б??????????、??PPOS?σ?Gn???、Gn???????????σ?(?<),PPOS?σ?HCG?P?????σ?(?<),?????σ????????????σ?(?<),????σ???????(?>);????σ??Gn???、Gn?????(?>);????σ??LH、E2?P??????????σ?;PPOS?σ?HCG??????????σ?(?<)(?2)。?????????б?(?±?)HCG???????Gn???Gn???/ULH/(U/L)E2/(pmol/L)P/(nmol/L)PPOS?σ?±*±*±*#±*#±*哪帋+5k`(汉????σ?±#±#±#±#±#哪帋+5k`(汉???σ?±±±±±+5k`(汉?:?????σ??б,*?<;????σ??б,#?<。?、?????????б?);PPOS?σ????????????σ?3??MⅡ??、???、???б?????????σ?(?<);PPOS?σ???????(?>)。PPOS?σ???????????????σ?、???σ???????(?>??σ?????σ?(?<),????σ?),?????σ????????σ?(?<?????;PPOS?σ??????σ????);PPOS?σ?OHSS????????????????????,)<?(?σ?????σ??,)<?(?σ?????σ?PPOS?σ??????σ?????????(?>OHSS?????(?3)。:..·336·??????2023?3??32??3????????????б?[(?±?),%]??????????????MⅡ?????PPOS?σ?±*#(219/536)#(404/536)(408/498)┅}7q3"(-创|????σ?±#(1306/3322)#(2346/3322)(2742/3321)┅}7q3"(-创|???σ?±(967/2801)(1980/2801)(2243/2787)┅}7q3"(-创|??????????б??????OHSS???PPOS?σ?(405/408)*#(75/191)(185/230)0*#}貂q後祆|????σ?(2661/2742)(500/1294)(1089/1307)#(4/177)#&}貂q後祆|???σ?(2182/2243)(346/936)(749/967)(13/170)&}貂q後祆|?:?????σ??б,*?<;????σ??б,#?<。?、?????????б?????????(?>);?????????3??????????(?>);PPOS?σ?,???σ???????????????σ???????????????σ?????σ?(?<),???????????,3?????(?<),????σ?????σ?????????????????(?>)(?4)。???????????б?(%)?????????????????????????PPOS?σ?(3/27)(22/43)(27/43)*#照技圹北2构'????σ?(34/157)(18/54)#(61/123)(157/177)照技北22构'???σ?(20/148)(63/100)(31/70)(148/170)照技北2构'?:?????σ??б,*?<;????σ??б,#?<。???PCOS?????????σ,?????????????。PCOS?PPOS?LH??????????????σ???Kuang?[17]??,???????????????,???FSH???????LH?,???????GnRH?????????????????????????????LH??????,?????PCOS??[10‐11]。FSH?????E2????、????????????????????????LH???????????????[12‐13]。E2???????????[18]。PCOS?????????????θ[14],???????????о??????????,????????Ч??[15]?????,?????????????????。??PCOS?????????????[19]?????(IR),?????????????????????,????????????[16],??э??????PCOS?????????????????,????????????????,????????????。???????????????、???????????????[17,20‐21],???????????Ч???ν????PCOS?????????LH???????????????????[22]。??,??PCOS???????????????????PPOS?Ч?390??????Ч。?????σ?σ?HCG?LH、E2???????PPOS?σ、????σ????σ???????,??PPOS????LH????????IVF?PCOS??????????,??????PPOS?Ч??????,??σGn???、Gn:..??????2023?3??32??3?·337·???????????б?,??PCOS??,?????????。????σ??????????????????,?????????σ????σ,PPOS?σ????,OHSS??????(FET),????????????????,??????????????????σ???FET????????。Bosdou?[23]?????σ,??????????????,??????????,?????????????,???σ???,??????????????FET??????/??OHSS???,??????3???????。??Ч???????[24]??????????,?????。Cui???,????????,????????????Zaat?[25]??????PPOS?σ??FET???????????Ч???。????ART?????,?????????[26][27]【????】????。Evans????????PPOS?σ??FET?????σ??FET?б,?Ч[1]LiznevaD,SuturinaL,WalkerW,,prevalence,??。??Ч?????,????PPOS?σνandphenotypesofpolycysticovarysyndrome[J].FertilSteril,2016,106:6‐15.???,?????????,?FET?????[2]ThakkerD,RavalA,PatelI,‐acetylcysteinefor??????,????????σ????σ?polycysticovarysyndrome:asystematicreviewandmeta‐????OHSS??????。analysisofrandomizedcontrolledclinicaltrials[J].Obstet?PPOS?σ??,????σ??????GynecolInt,2015,2015:817849.??GnRH??????????GnRH??,[3]KatulskiK,CzyzykA,Podfigurna‐StopaA,[J].???????LH?????????。???GynecolEndocrinol,2015,31:87‐91.??????,??????????GnRH??[4]McDonnellR,‐esfor?Ф??,?????,????σ???????womenwithpolycysticovarysyndrome[J].WomensHealth?????。]28]?LH???????????(Lond),2017,13:89‐97.[29][5]TandulwadkarSR,LodhaPA,???????????,?????GnRH????σ??????????plicationsinwomenwithIVFconceivedpregnanciesandpolycysticovariansyndrome[J].JHumReprodSci,2014,7:(HOXA‐10)??????,????????[30]13‐18.?,???.]J]???????????????.??,??]6]???)1‐AIF(1‐?????????????,??????????????‐α(TNF‐α)????,2018,34:737‐741.????,??????[31],?????Ч???[7]KadouraS,AlhalabiM,??????????????σ?,?????antagonistprotocolsversuslongGnRHagonistprotocolinIVF/ICSIcyclesofpolycysticovarysyndromewomen:a?????????。systematicreviewandmeta‐analysis[J].SciRep,2022,???σ??????GnRH??????12:4456.??,??????。?????σ????,??[8]LiS,WangJ,ChengY,?,????????????????σ???hCG‐acti