PCOS病人冻胚移植周期内膜准备方案的总结与分析
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摘要
多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期女性最常见的不孕症之一,由于该疾病涉及内分泌、代谢的紊乱,故IVF-ET时PCOS病人在控制性卵巢刺激过程中卵巢过度刺激综合征(Ovarian hyperstimulation syndrome,OHSS)的发生率高,鲜胚移植的妊娠率低,而冻胚移植可改善其妊娠结局,降低OHSS风险。影响冻胚移植成功率的因素包括胚胎质量、子宫内膜容受性和两者间的同步性,内膜准备方案是影响子宫内膜容受性与内膜胚胎同步性的重要因素。本文通过现有文献报道,对PCOS病人冻胚移植周期(frozen-thawed embryo transfer,FET)内膜准备方案进行归纳,总结出针对不同PCOS病人的最优方案,为进一步研究提供参考。
Patients with PCOS have a high rate of ovarian hyperstimulation syndrome(OHSS)after controlled ovary stimulation treatment in IVF-ET and a low rate of pregnancy in fresh embryo transfer.Frozen embryo transfer(FET) can improve the outcome of pregnancy in clinical and reduce the risk of OHSS.The factors that affect success rate of FET include embryo quality,endometrial receptivity and the synchronization between both of them.Endometrial preparation protocol is a significant factor which can impact endometrial receptivity and the synchronization of endometrial and embryo.In this study,endometrial preparation protocols for FET cycle in patients with PCOS is summarized through the existing literature and research.For the different types of PCOS patients,the optimal protocol is introduced,and the summarized relationship in this study can be the reference for further research.
Patients with PCOS have a high rate of ovarian hyperstimulation syndrome(OHSS)after controlled ovary stimulation treatment in IVF-ET and a low rate of pregnancy in fresh embryo transfer.Frozen embryo transfer(FET) can improve the outcome of pregnancy in clinical and reduce the risk of OHSS.The factors that affect success rate of FET include embryo quality,endometrial receptivity and the synchronization between both of them.Endometrial preparation protocol is a significant factor which can impact endometrial receptivity and the synchronization of endometrial and embryo.In this study,endometrial preparation protocols for FET cycle in patients with PCOS is summarized through the existing literature and research.For the different types of PCOS patients,the optimal protocol is introduced,and the summarized relationship in this study can be the reference for further research.
引文
[1]Group EC W.Health and fertility in world health organization group 2 anovulatory women[J].Human Reproduction Update,2012;18(5):586-599
[2]崔琳琳,陈子江.多囊卵巢综合征诊断标准和诊疗指南介绍[J].国际生殖健康/计划生育杂志,2011;(5):405-408
[3]Franks S,Stark J,Hardy K.Follicle dynamics and anovulation in polycystic ovary syndrome[J].Human Reproduction Update,2008;14(4):367-378
[4]Shapiro BS,Daneshmand ST,Garner FC,et al.Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization:a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders[J],2011;96(2):344-348
[5]Imudia AN,Awonuga AO,Kaimal AJ,et al.Elective cryopreservation of all embryos with subsequent cryothaw embryo transfer in patients at risk for ovarian hyperstimulation syndrome reduces the risk of adverse obstetric outcomes:a preliminary study[J].Fertil Steril,2013;99(1):168-173
[6]张轶乐,孙婧,苏迎春,等.新鲜和冻融胚胎移植妇女异位妊娠的发生率及其影响因素[J].中华妇产科杂志,2012;47(9):655-658
[7]Horcajadas JA,Mínguez P,Dopazo J,et al.Controlled ovarian stimulation induces a functional genomic delay of the endometrium with potential clinical implications[J].Journal of Clinical Endocrinology&Metabolism,2013;93(11):4500-4510
[8]赵诗艺,余璐萍,刘英,等.芬吗通内膜准备对多囊卵巢综合征病人冻融胚胎移植周期妊娠率的影响[J].生殖医学杂志,2015;24(5):381-385
[9]Weissman A,Levin D,Ravhon A,et al.What is the preferred method for timing natural cycle frozen-thawed embryo transfer[J].Reproductive Biomedicine Online,2009;19(1):66-71
[10]袁莹莹,景万红,吴昕,等.3种内膜准备方案在多囊卵巢综合征病人冻融胚胎移植中的应用比较[J].宁夏医学杂志,2015;37(9):775-777
[11]郭慧,龚斐,罗克丽,等.两种雌孕激素替代法内膜准备对多囊卵巢综合征冷冻胚胎移植临床效果的比较[J].中国现代医学杂志,2013;23(2):74-77
[12]Griesinger G,Weig M,Schroer A,et al.Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryo,Transfer cycles without pituitary suppression[J].Human Reproduction,2007;22(10):2589-2593
[13]Gelbaya TA,Nardo LG,Hunter HR,et al.Cryopreservedthawed embryo transfer in natural or down-regulated hormonally controlled cycles:a retrospective study[J].Fertility&Sterility,2006;85(3):603-609
[14]解迪,陈枝岚,周蓉,等.多囊卵巢综合征病人降调节后冻融胚胎移植周期的临床结局观察[J].生殖医学杂志,2014;23(9):714-718
[15]王晓燕,薛萍萍,张小魏,等.Pcos病人不同子宫内膜准备方案冻胚移植结局分析[J].现代妇产科进展,2015;(12):934-936
[16]Yu J.Endometrial preparation protocol of the frozenthawed embryo transfer in patients with polycystic ovary syndrome[J].Archives of Gynecology and Obstetrics,2015;291(1):201-211
[17]张娟辉,孔欣,侯哲,等.多囊卵巢综合征病人再次冻融胚胎移植内膜准备方案策略[J].中国妇幼保健,2013;28(9):1475-1477
[18]郭丽娜,吕翠婷,乜照燕,等.多囊卵巢综合征病人冻融胚胎移植3种内膜准备方案的临床结局比较[J].实用妇产科杂志,2010;26(7):538-541
[19]王晓燕,勾俊洁,彭真.来曲唑加尿促性素在多囊卵巢综合征病人冻融胚胎移植内膜准备中的应用[J].山东医药,2017;57(1):96-98
[20]陈士岭,何锦霞,宋华东,等.应用四种用药方案进行冻融胚胎移植的临床结局比较[J].南方医科大学学报,2007;27(3):303-306
[21]Hu YJ,Chen YZ,Zhu YM,et al.Letrozole stimulation in endometrial preparation for cryopreserved-thawed embryo transfer in women with polycystic ovarian syndrome:Apilot study[J].Clinical Endocrinology,2014;80(2):283-289
[22]Kar S.Clomiphene citrate or letrozole as first line ovulation induction drug in infertile pcos women:a prospective randomised trial[J].Journal of Human Reproductive Sciences,2012;98(3):262-5
[23]Forman R,Gill S,Moretti M,et al.Fetal safety of letrozole and clomiphene citrate for ovulation induction[J].J Obstet Gynaecol Can,2007;29(8):668-671
[2]崔琳琳,陈子江.多囊卵巢综合征诊断标准和诊疗指南介绍[J].国际生殖健康/计划生育杂志,2011;(5):405-408
[3]Franks S,Stark J,Hardy K.Follicle dynamics and anovulation in polycystic ovary syndrome[J].Human Reproduction Update,2008;14(4):367-378
[4]Shapiro BS,Daneshmand ST,Garner FC,et al.Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization:a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders[J],2011;96(2):344-348
[5]Imudia AN,Awonuga AO,Kaimal AJ,et al.Elective cryopreservation of all embryos with subsequent cryothaw embryo transfer in patients at risk for ovarian hyperstimulation syndrome reduces the risk of adverse obstetric outcomes:a preliminary study[J].Fertil Steril,2013;99(1):168-173
[6]张轶乐,孙婧,苏迎春,等.新鲜和冻融胚胎移植妇女异位妊娠的发生率及其影响因素[J].中华妇产科杂志,2012;47(9):655-658
[7]Horcajadas JA,Mínguez P,Dopazo J,et al.Controlled ovarian stimulation induces a functional genomic delay of the endometrium with potential clinical implications[J].Journal of Clinical Endocrinology&Metabolism,2013;93(11):4500-4510
[8]赵诗艺,余璐萍,刘英,等.芬吗通内膜准备对多囊卵巢综合征病人冻融胚胎移植周期妊娠率的影响[J].生殖医学杂志,2015;24(5):381-385
[9]Weissman A,Levin D,Ravhon A,et al.What is the preferred method for timing natural cycle frozen-thawed embryo transfer[J].Reproductive Biomedicine Online,2009;19(1):66-71
[10]袁莹莹,景万红,吴昕,等.3种内膜准备方案在多囊卵巢综合征病人冻融胚胎移植中的应用比较[J].宁夏医学杂志,2015;37(9):775-777
[11]郭慧,龚斐,罗克丽,等.两种雌孕激素替代法内膜准备对多囊卵巢综合征冷冻胚胎移植临床效果的比较[J].中国现代医学杂志,2013;23(2):74-77
[12]Griesinger G,Weig M,Schroer A,et al.Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryo,Transfer cycles without pituitary suppression[J].Human Reproduction,2007;22(10):2589-2593
[13]Gelbaya TA,Nardo LG,Hunter HR,et al.Cryopreservedthawed embryo transfer in natural or down-regulated hormonally controlled cycles:a retrospective study[J].Fertility&Sterility,2006;85(3):603-609
[14]解迪,陈枝岚,周蓉,等.多囊卵巢综合征病人降调节后冻融胚胎移植周期的临床结局观察[J].生殖医学杂志,2014;23(9):714-718
[15]王晓燕,薛萍萍,张小魏,等.Pcos病人不同子宫内膜准备方案冻胚移植结局分析[J].现代妇产科进展,2015;(12):934-936
[16]Yu J.Endometrial preparation protocol of the frozenthawed embryo transfer in patients with polycystic ovary syndrome[J].Archives of Gynecology and Obstetrics,2015;291(1):201-211
[17]张娟辉,孔欣,侯哲,等.多囊卵巢综合征病人再次冻融胚胎移植内膜准备方案策略[J].中国妇幼保健,2013;28(9):1475-1477
[18]郭丽娜,吕翠婷,乜照燕,等.多囊卵巢综合征病人冻融胚胎移植3种内膜准备方案的临床结局比较[J].实用妇产科杂志,2010;26(7):538-541
[19]王晓燕,勾俊洁,彭真.来曲唑加尿促性素在多囊卵巢综合征病人冻融胚胎移植内膜准备中的应用[J].山东医药,2017;57(1):96-98
[20]陈士岭,何锦霞,宋华东,等.应用四种用药方案进行冻融胚胎移植的临床结局比较[J].南方医科大学学报,2007;27(3):303-306
[21]Hu YJ,Chen YZ,Zhu YM,et al.Letrozole stimulation in endometrial preparation for cryopreserved-thawed embryo transfer in women with polycystic ovarian syndrome:Apilot study[J].Clinical Endocrinology,2014;80(2):283-289
[22]Kar S.Clomiphene citrate or letrozole as first line ovulation induction drug in infertile pcos women:a prospective randomised trial[J].Journal of Human Reproductive Sciences,2012;98(3):262-5
[23]Forman R,Gill S,Moretti M,et al.Fetal safety of letrozole and clomiphene citrate for ovulation induction[J].J Obstet Gynaecol Can,2007;29(8):668-671