Buyalos R P, Lee C T
Department of Obstetrics and Gynecology, University of California School of Medicine, Los Angeles, UCLA, USA.
Fertil Steril. 1996 Jan;65(1):1-10. doi: 10.1016/s0015-0282(16)58017-0.
To assess the efficacy of IVP-ET in infertile women with the polycystic ovary syndrome (PCOS) and to provide a comprehensive review of contemporary therapeutic options and their complications as reflected in the current literature.
Pertinent studies in medical literature identified through computerized bibliographic search and via manual review of relevant scientific publications.
In vitro fertilization and ET is an effective therapy for PCOS patients who are refractory to ovulation induction in vivo or who have coexisting infertility factors. The use of GnRH agonist (GnRH-a) is associated with significant reductions in the incidence of pregnancy loss and may improve fertilization and cleavage rates. In the PCOS patient, the use of purified FSH preparations does not appear to improve pregnancy rates nor other clinical parameters when compared with hMG. Severe ovarian hyperstimulation syndrome (OHSS) is an important consideration when PCOS patients undergo superovulation protocols. Strategies for OHSS prevention include the use of intravenous albumin immediately after oocyte retrieval, triggering of ovulation with a GnRH-a, or withholding menotropin therapy for several days before hCG administration. Cryopreservation of all embryos for future transfer in an artificial cycle has also proven to be an effective alternative in PCOS patients at high risk for severe OHSS.
Pregnancy rates for PCOS patients undergoing IVF-ET are comparable with those for women with tubal factor infertility. Therefore, IVF-ET should be offered to patients with PCOS who are refractory to conventional infertility modalities.
评估体外受精-胚胎移植（IVF-ET）治疗多囊卵巢综合征（PCOS）不孕女性的疗效，并全面综述当代治疗方法及其并发症，这些内容均反映在当前文献中。
通过计算机文献检索和人工查阅相关科学出版物，确定医学文献中的相关研究。
体外受精和胚胎移植对于体内促排卵难治或存在合并不孕因素的PCOS患者是一种有效的治疗方法。使用促性腺激素释放激素激动剂（GnRH-a）可显著降低流产发生率，并可能提高受精率和卵裂率。在PCOS患者中，与尿促性素（hMG）相比，使用纯化的促卵泡素（FSH）制剂似乎并不能提高妊娠率或其他临床指标。PCOS患者接受超促排卵方案时，严重卵巢过度刺激综合征（OHSS）是一个重要的考虑因素。预防OHSS的策略包括在取卵后立即使用静脉白蛋白、使用GnRH-a触发排卵，或在注射人绒毛膜促性腺激素（hCG）前几天停用促性腺激素治疗。对于有严重OHSS高风险的PCOS患者，冷冻保存所有胚胎以备将来在人工周期中移植也已被证明是一种有效的替代方法。
接受IVF-ET的PCOS患者的妊娠率与输卵管因素不孕女性的妊娠率相当。因此，对于常规不孕治疗方法难治的PCOS患者，应提供IVF-ET治疗。
