Reproductive Department, Hebei Institute of Reproductive Health Science and Technology, Shijiazhuang, 050071, Hebei, China.
Obstetrics Department, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050033, Hebei, China.
BMC Pregnancy Childbirth. 2023 Apr 13;23(1):247. doi: 10.1186/s12884-023-05546-0.
Clinical value of tumor necrosis factor (TNF) inhibitors in in vitro fertilization-embryo transfer (IVF-ET) in infertile women with polycystic ovary syndrome (PCOS) was investigated in this study.
A retrospective analysis was performed on the clinical data of 100 PCOS patients who received IVF-ET for the first time at Hebei Institute of reproductive health science and technology from January 2010 to June 2020. The patients were divided into Inhibitor group and Control group according to whether they were treated with or without TNF inhibitors. Next, the two groups were subject to comparison in terms of the days of gonadotropin (Gn) use, total dosage of Gn, trigger time, hormone level and endometrial condition on the day of human chorionic gonadotropin (HCG) injection, the effects of two different regimens on controlled ovarian hyperstimulation (COH) and pregnancy outcomes.
There were no significant differences in baseline characteristics between the two groups, including age, duration of infertility, body mass index (BMI), ovarian volume, antral follicle count, and basal hormone levels. Compared with the Control group, the days of Gn use and trigger time of patients in the Inhibitor group were significantly shortened, and the total Gn dosage was notably reduced. In terms of sex hormone levels on the HCG injection, the Inhibitor group displayed much lower serum estradiol levels while higher serum luteinizing hormone and progesterone (P) levels than the Control group. Notably, the high-quality embryo rate was also significantly increased with the use of TNF inhibitors. However, significant differences were not observed in endometrial thickness (on the day of HCG injection), proportion of endometrial A, B and C morphology (on the day of HCG injection), cycle cancellation rate, number of oocytes retrieved, fertilization rate, and cleavage rate between the two groups. Importantly, the clinical pregnancy rate in the Inhibitor group was significantly higher than that in the Control group, but there was no significant difference in the biochemical pregnancy rate, early abortion rate, multiple birth rate, ectopic pregnancy rate and number of live births between the two groups.
Collectively, after application of TNF-α inhibitor regimen, superior overall treatment effect can be observed in infertile PCOS patients receiving IVF-ET. Therefore, TNF inhibitors have certain application value in IVF-ET in infertile women with PCOS.
本研究旨在探讨肿瘤坏死因子（TNF）抑制剂在体外受精-胚胎移植（IVF-ET）治疗多囊卵巢综合征（PCOS）不孕妇女中的临床价值。
回顾性分析 2010 年 1 月至 2020 年 6 月在河北省生殖健康科学技术研究所首次接受 IVF-ET 的 100 例 PCOS 患者的临床资料。根据是否使用 TNF 抑制剂将患者分为抑制剂组和对照组。然后，比较两组患者的促性腺激素（Gn）使用天数、Gn 总量、扳机时间、HCG 注射日激素水平和子宫内膜情况、两种不同方案对控制性卵巢过度刺激（COH）的影响以及妊娠结局。
两组患者的基线特征（年龄、不孕时间、体质量指数（BMI）、卵巢体积、窦卵泡数、基础激素水平）无显著差异。与对照组相比，抑制剂组患者的 Gn 使用天数和扳机时间明显缩短，Gn 总量明显减少。在 HCG 注射日性激素水平方面，抑制剂组血清雌二醇水平明显降低，而血清黄体生成素和孕酮（P）水平明显升高。值得注意的是，使用 TNF 抑制剂可显著提高优质胚胎率。然而，两组患者 HCG 注射日子宫内膜厚度、HCG 注射日子宫内膜 A、B、C 形态比例、周期取消率、获卵数、受精率、卵裂率均无显著差异。重要的是，抑制剂组的临床妊娠率明显高于对照组，但两组的生化妊娠率、早期流产率、多胎妊娠率、异位妊娠率和活产数均无显著差异。
总之，TNF-α抑制剂方案应用后，可观察到接受 IVF-ET 的 PCOS 不孕患者的整体治疗效果更佳。因此，TNF 抑制剂在 PCOS 不孕患者的 IVF-ET 中具有一定的应用价值。
