不同ABO血型PCO/PCOS患者IVF助孕过程卵巢反应及临床结局分析
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摘要
目的研究不同ABO血型的多囊卵巢/多囊卵巢综合征(PCO/PCOS)不孕症患者在IVF-ET过程中的卵巢反应及临床结局分析。方法选择2012年1月至2017年6月在我院生殖中心采用长方案降调节行IVF-ET治疗不孕症的PCO/PCOS患者3 918例(共3 918个周期)进行回顾性分析。根据患者的血型不同分为O、A、B、AB型4组,比较各组患者的一般资料、促排卵情况及妊娠结局。结果 4组患者的年龄、体重指数(BMI)、不孕年限、基础FSH水平、基础E2水平、HCG扳机日E2水平、优质胚胎数、Gn天数、Gn总用量、迟发型卵巢过度刺激综合征(OHSS)发生率、临床妊娠率、种植率、早期流产率、健康婴儿出生率等比较均无显著性差异(P>0.05)。A型血患者获取的成熟卵母细胞数、早发型OHSS发生率显著高于其他血型组(P<0.05)。结论 A型血PCO/PCOS患者卵巢反应性可能较其他血型患者更高,获取卵母细胞数较多,更易发生早发型OHSS。
Objective:To investigate the ovarian response and clinical outcomes of infertile patients with polycystic ovary/polycystic ovary syndrome(PCO/PCOS)and different ABO blood groups during in IVF-ET.Methods:A retrospective analysis was done on 3 918 PCO/PCOS infertile patients who received long protocol down regulation in IVF-ET in Drum Tower Hospital Affiliated to Nanjing University from January 2012 to June 2017.According to the patient's blood type,the patients were divided into type O,A,B,and AB groups.The general information,ovulation induction and pregnancy outcomes of each group were compared.Results:There were no significant differences in age,BMI,duration of infertility,basic FSH,basic E2 levels,E2 levels on HCG day,number of high quality embryos,total doses and days of gonadotropin used,incidence of late ovarian hyperstimulation syndrome(OHSS),clinical pregnancy rate,embryo implantation rate,early abortion rate and healthy infant birth rate among the four groups(P>0.05).The number of mature oocyte and the incidence of early OHSS in patients with type A blood were significantly higher than those with other blood types(P<0.05).Conclusions:The ovarian response and the number of mature oocyte retrieved in PCO/PCOS patients with type A blood are significantly higher than those in the patients with other blood type group.The PCO/PCOS patients with type A blood is more prone to early onset OHSS.
Objective:To investigate the ovarian response and clinical outcomes of infertile patients with polycystic ovary/polycystic ovary syndrome(PCO/PCOS)and different ABO blood groups during in IVF-ET.Methods:A retrospective analysis was done on 3 918 PCO/PCOS infertile patients who received long protocol down regulation in IVF-ET in Drum Tower Hospital Affiliated to Nanjing University from January 2012 to June 2017.According to the patient's blood type,the patients were divided into type O,A,B,and AB groups.The general information,ovulation induction and pregnancy outcomes of each group were compared.Results:There were no significant differences in age,BMI,duration of infertility,basic FSH,basic E2 levels,E2 levels on HCG day,number of high quality embryos,total doses and days of gonadotropin used,incidence of late ovarian hyperstimulation syndrome(OHSS),clinical pregnancy rate,embryo implantation rate,early abortion rate and healthy infant birth rate among the four groups(P>0.05).The number of mature oocyte and the incidence of early OHSS in patients with type A blood were significantly higher than those with other blood types(P<0.05).Conclusions:The ovarian response and the number of mature oocyte retrieved in PCO/PCOS patients with type A blood are significantly higher than those in the patients with other blood type group.The PCO/PCOS patients with type A blood is more prone to early onset OHSS.
引文
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[13]Practice Committee of the American Society for Reproductive Medicine.Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome:a guideline[J].Fertil Steril,2016,106:1634-1647.
[14]Gates MA,Wolpin BM,Cramer DW,et al.ABO blood group and incidence of epithelial ovarian cancer[J].Int J Cancer,2011,128:482-486.
[15]Sharara AI,Abdul-Baki H,ElHajj I,et al.Association of gastroduodenal disease phenotype with ABO blood group and Helicobacter pylori virulence-specific serotypes[J].Dig Liver Dis,2006,38:829-833.
[16]Jenkins PV,O’Donnell JS.ABO blood group determines plasma von Willebrand factor levels:a biologic function after all?[J].Transfusion,2006,46:1836-1844.
[17]Matalliotakis I,Cakmak H,Goumenou A,et al.ABO and Rh blood groups distribution in patients with endometriosis[J].Arch Gynecol Obstet,2009,280:917-919.
[18]Yuzhalin AE,Kutikhin AG.ABO and Rh blood groups in relation to ovarian,endometrial and cervical cancer risk among the population of South-East Siberia[J].Asian Pac J Cancer Prev,2012,13:5091-5096.
[19]Behrman SJ,Buettner-Janusch J,Heglar R,et al.ABO(H)blood incompatibility as a cause of infertility:a new concept[J].Am J Obstet Gynecol,1960,79:847-855.
[20]Binder H,Flegel WA,Emran J,et al.Association of blood group A with early-onset ovarian hyperstimulation syndrome[J].Transfus Clin Biol,2008,15:395-401.
[21]Bellver J,Ferrando M,Garrido N,et al.Blood group and ovarian hyperstimulation syndrome[J].Fertil Steril,2010,93:270-271.
[22]Nejat EJ,Jindal S,Berger D,et al.Implications of blood type for ovarian reserve[J].Hum Reprod,2011,26:2513-2517.
[23]Mu L,Jin W,Yang H,et al.ABO blood type is associated with ovarian reserve in Chinese women with subfertility[J].Oncotarget,2016,7:50908-50913.
[24]Lin S,Li R,Chi H,et al.Effect of ABO blood type on ovarian reserve in Chinese women[J].Fertil Steril,2014,102:1729-1732.
[25]Sengül O,Dilbaz B,Yerebasmaz N,et al.Only female age,and not blood type,is associated with ovarian reserve[J].Int JFertil Steril,2014,8:143-146.
[26]李娜,师娟子.激动剂长方案中卵巢过度刺激综合征的预防[J].生殖医学杂志,2015,24:783-789.
[27]Binder H,Dittrich R,Einhaus F,et al.Update on ovarian hyperstimulation syndrome:Part 1-incidence and pathogenesis[J].Int J Fertil Womens Med,2007,52:11-26.
[28]Rizk B.Symposium:Update on prediction and management of OHSS.Genetics of ovarian hyperstimulation syndrome[J/OL].Reprod Biomed Online,2009,19:14-27.
[29]戴芳芳,郑波,许晓立,等.不同血型患者在体外受精-胚胎移植助孕过程中的对比分析[J].中国优生与遗传杂志,2016,24:94-96.
[30]Ogawa S,Minakami H,Araki S,et al.A rise of the serum level of Von Willebrand factor occurs before clinical manifestation of the severe form of ovarian hyperstimulation syndrome[J].J Assist Reprod Genet,2001,18:114-119.
[2]Ramer I,Kruczek A,Doulaveris G,et al.Reduced circulating concentration of brain-derived neurotrophic factor is associated with peri-and post-implantation failure following in vitro fertilizationembryo transfer[J].Am J Reprod Immunol,2016,75:36-41.
[3]Pereira N,Hutchinson AP,Bender JL,et al.Is ABO blood type associated with ovarian stimulation response in patients with diminished ovarian reserve?[J].J Assist Reprod Genet,2015,32:985-990.
[4]Spitzer D,Corn C,Stadler J,et al.Implications of blood type for ovarian reserve and infertility-impact on oocyte yield in IVFpatients[J].Geburtshilfe Frauenheilkd,2014,74:928-932.
[5]Deng J,Jia M,Cheng X,et al.ABO blood group and ovarian reserve:a meta-analysis and systematic review[J].Oncotarget,2017,8:25628-25636.
[6]Awartani K,Al Ghabshi R,Al Shankiti H,et al.Association of blood groups with ovarian reserve and outcome of in vitro fertilization treatment[J].Ann Saudi Med,2016,36:116-120.
[7]Pereira N,Hutchinson AP,Bender JL,et al.Is ABO blood type associated with ovarian stimulation response in patients with diminished ovarian reserve?[J].J Assist Reprod Genet,2015,32:985-990.
[8]Binder H,Flegel WA,Emran J,et al.Blood group A:an overseen risk factor for early-onset ovarian hyperstimulation syndrome?[J/OL].Reprod Biomed Online,2008,17:185-189.
[9]Bottini N,Meloni GF,Finocchi A,et al.Maternal-fetal interaction in the ABO system:a comparative analysis of healthy mothers and couples with recurrent spontaneous abortion suggests a protective effect of B incompatibility[J].Hum Biol,2001,73:167-174.
[10]石青青,王玢,陈华,等.腹腔镜下输卵管结扎与切除术对输卵管积水患者IVF妊娠结局分析[J].中国妇幼健康研究,2017,28:296-298.
[11]Mathur RS,Akande AV,Keay SD,et al.Distinction between early and late ovarian hyperstimulation syndrome[J].Fertil Steril,2000,73:901-907.
[12]Papanikolaou EG,Tournaye H,Verpoest W,et al.Early and late ovarian hyperstimulation syndrome:early pregnancy outcome and profile[J].Hum Reprod,2005,20:636-641.
[13]Practice Committee of the American Society for Reproductive Medicine.Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome:a guideline[J].Fertil Steril,2016,106:1634-1647.
[14]Gates MA,Wolpin BM,Cramer DW,et al.ABO blood group and incidence of epithelial ovarian cancer[J].Int J Cancer,2011,128:482-486.
[15]Sharara AI,Abdul-Baki H,ElHajj I,et al.Association of gastroduodenal disease phenotype with ABO blood group and Helicobacter pylori virulence-specific serotypes[J].Dig Liver Dis,2006,38:829-833.
[16]Jenkins PV,O’Donnell JS.ABO blood group determines plasma von Willebrand factor levels:a biologic function after all?[J].Transfusion,2006,46:1836-1844.
[17]Matalliotakis I,Cakmak H,Goumenou A,et al.ABO and Rh blood groups distribution in patients with endometriosis[J].Arch Gynecol Obstet,2009,280:917-919.
[18]Yuzhalin AE,Kutikhin AG.ABO and Rh blood groups in relation to ovarian,endometrial and cervical cancer risk among the population of South-East Siberia[J].Asian Pac J Cancer Prev,2012,13:5091-5096.
[19]Behrman SJ,Buettner-Janusch J,Heglar R,et al.ABO(H)blood incompatibility as a cause of infertility:a new concept[J].Am J Obstet Gynecol,1960,79:847-855.
[20]Binder H,Flegel WA,Emran J,et al.Association of blood group A with early-onset ovarian hyperstimulation syndrome[J].Transfus Clin Biol,2008,15:395-401.
[21]Bellver J,Ferrando M,Garrido N,et al.Blood group and ovarian hyperstimulation syndrome[J].Fertil Steril,2010,93:270-271.
[22]Nejat EJ,Jindal S,Berger D,et al.Implications of blood type for ovarian reserve[J].Hum Reprod,2011,26:2513-2517.
[23]Mu L,Jin W,Yang H,et al.ABO blood type is associated with ovarian reserve in Chinese women with subfertility[J].Oncotarget,2016,7:50908-50913.
[24]Lin S,Li R,Chi H,et al.Effect of ABO blood type on ovarian reserve in Chinese women[J].Fertil Steril,2014,102:1729-1732.
[25]Sengül O,Dilbaz B,Yerebasmaz N,et al.Only female age,and not blood type,is associated with ovarian reserve[J].Int JFertil Steril,2014,8:143-146.
[26]李娜,师娟子.激动剂长方案中卵巢过度刺激综合征的预防[J].生殖医学杂志,2015,24:783-789.
[27]Binder H,Dittrich R,Einhaus F,et al.Update on ovarian hyperstimulation syndrome:Part 1-incidence and pathogenesis[J].Int J Fertil Womens Med,2007,52:11-26.
[28]Rizk B.Symposium:Update on prediction and management of OHSS.Genetics of ovarian hyperstimulation syndrome[J/OL].Reprod Biomed Online,2009,19:14-27.
[29]戴芳芳,郑波,许晓立,等.不同血型患者在体外受精-胚胎移植助孕过程中的对比分析[J].中国优生与遗传杂志,2016,24:94-96.
[30]Ogawa S,Minakami H,Araki S,et al.A rise of the serum level of Von Willebrand factor occurs before clinical manifestation of the severe form of ovarian hyperstimulation syndrome[J].J Assist Reprod Genet,2001,18:114-119.