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目的:探讨改良超长方案降调节结合人绝经期促性腺激素(h MG)在多囊卵巢综合征(PCOS)不孕患者行体外受精/卵胞质内单精子注射-胚胎移植术(IVF/ICSI-ET)助孕中的疗效及机理。方法:1将行IVF/ICSI-ET的PCOS患者随机改良超长方案降调后促排卵组(A组,n=86)和标准的长效长方案促排卵组(B组,n=80);观察比较2种促排方案的实验室及临床结局。2分别于取卵后第6日收集A组和B组中因卵巢过度刺激综合征(OHSS)原因取消移植者的子宫内膜组织各5例(分别为C组和D组),用电子显微镜、Real-time PCR和Western blotting、免疫组织化学方法观察内膜组织胞饮突分布以及同源框A10(HOXA10)、溶血磷脂酸受体3(LPAR3)、环氧化酶2(COX2)基因的表达变化。结果:1 Gn用量(IU)、用药时间(d)、h CG注射日E2水平和LH水平、平均获卵数、受精率、优质胚胎率、周期取消率、移植胚胎数、重度OHSS发生率、流产率、异位妊娠率A、B组间均无统计学差异(P>0.05)。A组种植率及移植妊娠率(60.65%和79.49%)均高于B组(44.53%和61.19%,P<0.05)。与B组相比,A组患者h CG注射日P水平及P/E2明显降低,子宫内膜(EM)的厚度、形态、血流情况明显改善(P<0.05)。2 C组子宫内膜上出现大量呈蘑菇状、表面光滑、边界清楚的完全发育胞饮突,D组的胞饮突的数量少于C组,且形态发育不佳,还可见少量退化的胞饮突。在着床期C组子宫内膜LPAR3、COX2、HOXA10的表达水平显著高于D组。结论:对PCOS不孕患者实施IVF/ICSI-ET助孕过程中,采用改良的Gn RH-a超长方案降调节+h MG超促排卵可通过多种机理提高患者的着床率和妊娠率。
OBJECTIVE: To investigate the effects of modified long-term regimen combined with human menopausal gonadotrophin (h MG) on in vitro fertilization / intracytoplasmic sperm injection (IVF / ICSI) in infertile women with polycystic ovary syndrome (PCOS) -ET) in the efficacy and mechanism of pregnancy. Methods: 1 PCOS patients with IVF / ICSI-ET were randomized to receive ovulation induction (A group, n = 86) and standard long-term ovulation induction (B group, n = 80) ; Observed and compared two kinds of promotion program of laboratory and clinical outcomes. 2, 5 cases of endometrial tissue (group C and group D, respectively) whose cancers were abolished due to ovarian hyperstimulation syndrome (OHSS) in group A and group B were collected on the 6th day after ovulation, respectively. Electron microscopy Real-time PCR and Western blotting were used to detect the distribution of invaginal processes and the expression of HOXA10, LPAR3 and COX2 genes in endometrial tissues by immunohistochemistry Change of expression Results: The levels of E2 and LH, the number of oocytes retrieved, the fertilization rate, the rate of high quality embryos, the rate of abolished cycles, the number of embryos transferred, the incidence of severe OHSS, Abortion rate, ectopic pregnancy rate A, B were no significant difference between groups (P> 0.05). Group A implantation rate and pregnancy rate (60.65% and 79.49%) were higher than those in group B (44.53% and 61.19%, P <0.05). Compared with group B, the P level and P / E2 of h CG injection in group A were significantly decreased, and the thickness, shape and blood flow of endometrium were significantly improved (P <0.05). 2 C group showed a large number of mushrooms on the endometrium, smooth surface, clear boundary of the complete development of the drinking process, the number of group D group of pinopodes less than C group, and the morphological development is poor, but also a small amount of degraded cells Drink suddenly. At implantation stage, the expression levels of LPAR3, COX2 and HOXA10 in endometrium of group C were significantly higher than those of group D. CONCLUSION: In the process of IVF / ICSI-ET assisted pregnancy in PCOS infertility patients, the improved Gn RH-a long-term regimen can down-regulate + h MG over-ovulation to improve the implantation rate and pregnancy rate through various mechanisms .