摘要
目的 探究体重指数(BMI)对于PCOS患者IVF/ICSI治疗过程及结局的影响。方法 回顾性分析2015~2016年在我中心就诊的1323名PCOS患者(1323个IVF/ICSI助孕周期)的临床资料。PCOS诊断参照RotterdamESHRE/ASRM标准。按照BMI值(亚洲标准)分为偏瘦/正常体重组(BMI<24kg/m^2)、超重组(24≤BMI<28kg/m^2)、肥胖组(BMI≥28kg/m^2),并以不同授精方式分为IVF亚组和ICSI亚组,分析各组的促排卵情况有无差异;再从所有周期中筛选出进行了鲜胚移植的800个周期,仍按照上述BMI标准分为偏瘦/正常组、超重组和肥胖组,又按授精方式分为IVF亚组和ICSI亚组,比较各组的促排卵情况和临床结局。结果 1323个IVF/ICSI周期中偏瘦/正常组、超重组及肥胖组的Gn用量、Gn天数比较存在显著性差异(P<0.001),偏瘦/正常组Gn用量最少、Gn时间最短,肥胖组Gn用量最多、Gn时间最长。偏瘦/正常组的扳机日E2和P水平、获卵数显著高于超重组和肥胖组(P<0.05);偏瘦/正常组的预防OHSS取消移植率和中重度OHSS发生率显著高于超重组和肥胖组(P<0.05)。比较3组患者的IVF亚组和ICSI亚组胚胎形成结局,结果显示:偏瘦/正常组IVF亚组的可利用胚胎数、可利用胚胎率显著高于超重组、肥胖组的IVF亚组;偏瘦/正常组ICSI亚组的可利用胚胎数、可利用胚胎率显著高于超重组ICSI亚组;偏瘦/正常组IVF亚组的有囊胚形成周期率显著高于超重组IVF亚组(P均<0.05)。进行鲜胚移植的800个周期中,3组IVF亚组间生化妊娠率、临床妊娠率、活产率、异位妊娠率和早期自然流产率比较均无显著性差异(P>0.05);3组ICSI亚组的各观察指标比较亦无显著性差异(P>0.05);随着BMI增加,偏瘦/正常组、超重组及肥胖组IVF亚组的胚胎种植率呈下降趋势,但尚无显著性差异(P>0.05)。结论 在进行IVF/ICSI助孕的PCOS患者中,BMI升高可能会影响促排卵反应,导致Gn用量增加、Gn促排天数延长。虽然不同BMI各组的妊娠结局尚无显著性差异,但随着BMI增加,IVF亚组的胚胎种植率呈略下降的趋势,因此,临床工作中对于行助孕治疗前PCOS患者的BMI控制仍应给予一定重视。
Objective : To explore the impacts of body mass index(BMI) on the outcome of IVF/ICSI in patients with PCOS. Methods : A total of 1 323 IVF/ICSI cycles in the patients with PCOS from January 2015 to December 2016 were included. They were divided into three groups according to the recommended Asian BMI cut-off points:underweight/normal weight(BMI<24 kg/m^ 2), overweight(24≤ BMI<28 kg/m^ 2 ) and obese(BMI≥ 28 kg/m ^2). The cycles were also subdivided into IVF and ICSI group by different insemination methods. The ovarian stimulation characteristics among the groups were investigated. Then 800 fresh embryo transfer cycles were selected and divided into three groups as above:underweight/normal weight,overweight and obese,and then subdivided into IVF and ICSI group. The ovulation induction and clinical outcomes were analyzed among the groups, Results : There were significant differences in the amount and days of Gn used among the underweight/normal weight,overweight and obese group in the 1 323 IVF/ICSI cycles( P <0.001). The obese patients with PCOS needed the most amount of Gn and longest Gn days,while the underweight/normal weight patients with PCOS needed the least amount of Gn and the shortest Gn days. The E 2 & progesterone levels on HCG trigger day and the oocytes retrieved in the underweight/normal weight patients were significantly higher than the overweight and obese patients( P <0.05). The incidences of severe OHSS and cancelled cycles for preventing OHSS were significantly higher in the underweight/normal weight group compared to overweight and obese group( P <0.05). Comparing the embryo formation outcome of IVF and ICSI subgroup among the three groups,the available embryos and available embryo rate were significantly higher in the underweight/normal weight group compared to overweight group and obese group( P <0.05). The number and rate of available embryos were significantly higher in the underweight/normal weight ICSI subgroup compared to overweight and obese ICSI subgroup( P <0.05). The blastocyst formation cycle rate in the underweight/normal weight IVF subgroup was significantly higher compared to overweight IVF subgroup( P <0.05). There were no significant differences in biochemical pregnancy rate,clinical pregnancy rate,live birth rate,ectopic pregnancy rate and early spontaneous abortion of IVF subgroups among the three groups in the 800 fresh embryo transfer cycles( P >0.05). There were no significant differences in the observation indexes of the ICSI subgroup ( P >0.05). With the increase of BMI,the embryo implantation rate of the IVF subgroup of the underweight/normal group,the overweight group and the obese group showed a downward trend,but there was no significant difference( P >0.05). Conclusions : In patients with PCOS undergone IVF/ICSI treatment,elevated BMI may affect the ovulation induction response,resulting in increased the amount and days of Gn used. Although there was no significant difference in the pregnancy outcomes of different BMI groups,the implantation rate of IVF subgroup decreases slightly with the increase of BMI. Therefore,the clinicians should pay more attention to BMI control of PCOS patients before assisted pregnancy.
作者
山惠枝
沈晓月
蒋玥
晏媛
孙海翔
SHAN Hui-zhi;SHEN Xiao-yue;JIANG Yue;YAN Yuan;SUN Hai-xiang(Reproductive Medicine Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008)
出处
《生殖医学杂志》
CAS
2019年第6期629-635,共7页
Journal of Reproductive Medicine
基金
中华医学会临床医学科研专项资金-生殖医学青年医师研究与发展项目(17020450714)
作者简介
山惠枝,女,江苏镇江人,硕士,医师,生殖医学专业;通讯作者:孙海翔.
