Wang Yun, Chen Qiuju, Wang NingLing, Chen Hong, Lyu Qifeng, Kuang Yanping
From the Department of Assisted Reproduction, Shanghai Ninth People's Hospital, JiaoTong University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2016 Mar;95(9):e2939. doi: 10.1097/MD.0000000000002939.
Ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation is a current challenge for patients with polycystic ovarian syndrome (PCOS). Our previous studies indicated that progestin can prevent premature luteinizing hormone (LH) surge or moderate/severe OHSS in the general subfertile population, both in the follicular-phase and luteal-phase ovarian stimulation but it is unclear if this is true for patients with PCOS. The aim of the article was to analyze cycle characteristics and endocrinological profiles using human menopausal gonadotropin (hMG) in combination with medroxyprogesterone acetate (MPA) for PCOS patients who are undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments and investigate the subsequently pregnancy outcomes of frozen embryo transfer (FET). In the randomized prospective controlled study, 120 PCOS patients undergoing IVF/ICSI were recruited and randomly classified into 2 groups according to the ovarian stimulation protocols: hMG and MPA (group A, n = 60) or short protocol (group B, n = 60). In the study group, hMG (150-225IU) and MPA (10 mg/d) were administered simultaneously beginning on cycle day 3. Ovulation was cotriggered by a gonadotropinreleasing hormone (GnRH) agonist (0.1 mg) and hCG (1000IU) when dominant follicles matured. A short protocol was used as a control. The primary end-point was the ongoing pregnancy rate per transfer and incidence of OHSS. Doses of hMG administrated in group A are significantly higher than those in the controls. LH suppression persisted during ovarian stimulation and no incidence of premature LH surge was seen in both groups. The fertilization rate and the ongoing pregnant rate in the study group were higher than that in the control. The number of oocytes retrieved, mature oocytes, clinical pregnancy rates per transfer, implantation rates, and cumulative pregnancy rates per patient were comparable between the 2 groups. The incidence of OHSS was low between the 2 groups, with no significant difference. The study showed that MPA has the advantages of an oral administration route, easy access, more control over LH levels. A possible reduction in the incidence of moderate or severe OHSS with the MPA protocol should be viewed with caution as the data is small. Large randomized trials with adequate sample size remain necessary.
卵巢刺激过程中的卵巢过度刺激综合征（OHSS）是多囊卵巢综合征（PCOS）患者当前面临的一项挑战。我们之前的研究表明，孕激素可预防一般亚生育人群在卵泡期和黄体期卵巢刺激过程中过早出现促黄体生成素（LH）峰或中度/重度OHSS，但PCOS患者是否如此尚不清楚。本文的目的是分析接受体外受精/卵胞浆内单精子注射（ICSI）治疗的PCOS患者使用人绝经期促性腺激素（hMG）联合醋酸甲羟孕酮（MPA）时的周期特征和内分泌情况，并研究随后冻融胚胎移植（FET）的妊娠结局。在这项随机前瞻性对照研究中，招募了120例接受IVF/ICSI的PCOS患者，并根据卵巢刺激方案随机分为2组：hMG和MPA组（A组，n = 60）或短方案组（B组，n = 60）。研究组从周期第3天开始同时给予hMG（150 - 225IU）和MPA（10mg/d）。当优势卵泡成熟时，用促性腺激素释放激素（GnRH）激动剂（0.1mg）和hCG（1000IU）共同触发排卵。采用短方案作为对照。主要终点是每次移植的持续妊娠率和OHSS的发生率。A组给予的hMG剂量显著高于对照组。卵巢刺激期间LH抑制持续存在，两组均未出现过早LH峰。研究组的受精率和持续妊娠率高于对照组。两组之间的获卵数、成熟卵母细胞数、每次移植的临床妊娠率、着床率和每位患者的累积妊娠率相当。两组之间OHSS的发生率较低，无显著差异。研究表明，MPA具有口服给药途径、易于获取、对LH水平控制更强的优点。由于数据量较小，对于MPA方案可能降低中度或重度OHSS发生率这一点应谨慎看待。仍有必要进行足够样本量的大型随机试验。
