卵泡期 GnRH 激动剂方案是 LH/FSH 较低和 AMH 水平较低的多囊卵巢综合征患者的另一种选择，不会增加严重 OHSS 风险。
Follicular-Phase GnRH Agonist Protocol Is Another Choice for Polycystic Ovary Syndrome Patients With Lower LH/FSH and Lower AMH Levels Without Increasing Severe OHSS Risk.
机构信息
The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 10;13:905263. doi: 10.3389/fendo.2022.905263. eCollection 2022.
PURPOSE
To explore another choice for a controlled ovarian stimulation (COS) protocol that does not increase severe ovarian hyperstimulation syndrome (OHSS) risk among polycystic ovarian syndrome (PCOS) patients with specific clinical features.
METHODS
A retrospective study was performed. Two hundred and fifty-nine participants were divided into two groups, group 1 (fixed GnRH antagonist protocol, n = 295) and group 2 (follicular-phase GnRH agonist protocol, n = 69) according to COS protocols. The basic characteristics and laboratory indicators between these two groups were compared. The severe OHSS rate and clinical pregnancy rate were selected as indicators to evaluate the risks and benefits of the two COS protocols. Subgroup analyses for the severe OHSS rate and clinical pregnancy rate were performed based on baseline luteinizing hormone/follicle-stimulating hormone (bLH/FSH) and anti-Mullerian hormone (AMH) levels.
RESULTS
The severe OHSS rate was statistically higher in group 2 than in group 1 (11.6% vs. 3.7%, p = 0.008), but the biochemical pregnancy rate and clinical pregnancy rate showed no statistical difference between the groups (71.9% vs. 60.3% and 62.5% vs. 54.3%). In the higher bLH/FSH subgroup (≥1.33) and the higher serum AMH level subgroup (>3.4 ng/ml), severe OHSS incidence was statistically higher in group 2 compared to group 1, but this incidence was lower in the bLH/FSH subgroup (<1.33) and the subgroup with lower serum AMH levels (≤3.4 ng/ml); a difference in severe OHSS risk was not observed. There was no statistical difference between the two groups regarding clinical pregnancy rate in any subgroup.
CONCLUSION
The limited evidence from this study indicates that in PCOS patients with lower bLH/FSH levels (<1.33) and lower serum AMH levels (≤3.4 ng/ml), a follicular-phase GnRH agonist protocol may be another choice that does not increase the risk of severe OHSS.
目的
探索一种新的控制性卵巢刺激（COS）方案，用于具有特定临床特征的多囊卵巢综合征（PCOS）患者，以降低重度卵巢过度刺激综合征（OHSS）的风险。
方法
本研究为回顾性研究。根据 COS 方案，将 259 名参与者分为两组，组 1（固定 GnRH 拮抗剂方案，n = 295）和组 2（卵泡期 GnRH 激动剂方案，n = 69）。比较两组的基本特征和实验室指标。选择重度 OHSS 发生率和临床妊娠率作为评估两种 COS 方案风险和获益的指标。基于基础黄体生成素/卵泡刺激素（bLH/FSH）和抗苗勒管激素（AMH）水平，对重度 OHSS 发生率和临床妊娠率进行亚组分析。
结果
组 2 的重度 OHSS 发生率明显高于组 1（11.6% vs. 3.7%，p = 0.008），但两组的生化妊娠率和临床妊娠率无统计学差异（71.9% vs. 60.3%和 62.5% vs. 54.3%）。在较高的 bLH/FSH 亚组（≥1.33）和较高的血清 AMH 水平亚组（>3.4 ng/ml）中，组 2 的重度 OHSS 发生率明显高于组 1，但在 bLH/FSH 亚组（<1.33）和血清 AMH 水平较低的亚组（≤3.4 ng/ml）中，重度 OHSS 的发生率较低；重度 OHSS 风险无差异。在任何亚组中，两组的临床妊娠率均无统计学差异。
结论
本研究的有限证据表明，对于 bLH/FSH 水平较低（<1.33）和血清 AMH 水平较低（≤3.4 ng/ml）的 PCOS 患者，卵泡期 GnRH 激动剂方案可能是另一种不增加重度 OHSS 风险的选择。
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