比较GnRH激动剂长方案与GnRH拮抗剂方案对LH/FSH比值大于等于2的多囊卵巢综合征患者临床结局影响

目的:探讨促性腺激素释放激素（GnRH）激动剂长方案与GnRH拮抗剂方案对LH/FSH比值大于等于2的多囊卵巢综合征（ PCOS）患者胎质量影响及助孕结局的差别。方法:回顾性分析本中心多囊卵巢综合征患者行体外受精-胚胎移植（IVF-ET），将月经第3天LH/FSH比值为2设为临界值分为比值升高组（58个周期）和比值未升高组（248个周期），分析比较两组基础临床资料，再分别根据不同促排卵方案分为GnRH激动剂长方案与GnRH拮抗剂方案组，根据LH/FSH的比值不同探讨不同促排卵方案对PCOS患者胚胎质量及妊娠结局的影响。结果:首次分组，LH/FSH≥2组Gn总量少于LH/FSH<2组（P<0.05），胚胎质量及临床结局无统计学差异（P>0.05）；再次分组，在LH/FSH≥2前提下应用GnRH拮抗剂方案组促性腺激素（Gn）总量、Gn总天数少于GnRH激动剂长方案组（P<0.05），获卵数、正常受精数、正常卵裂数、优胚数均优于GnRH激动剂长方案组（P<0.05）。结论:PCOS患者中月经第3天LH/FSH比值以2为临界值可能对胚胎质量及临床结局无显著影响，LH/FSH临界值≥2的PCOS患者应用GnRH拮抗剂方案临床结局明显优于GnRH激动剂长方案。

Effects of different GnRH-analogue on polycystic ovarian syndrome with LH/FSH ratioof 2 or higher

Objective: To explore the effect of different GnRH-analogue on the quality of embryos and the outcome of pregnancy in patients with polycystic ovary syndrome (PCOS) with LH/FSH ratio of 2 or higher. Methods: With the PCOS patients day-3 LH/FSH ratio of 2 as the critical value, the data of 58 cycles which ratio greater than or equal to 2 and the data of 248 cycles which ratio less than 2 were analyzed retrospectively. And then the subjects were again divided into GnRH antagonist protocol group and GnRH agonist protocol group according to different GnRH-analogue. In the light of the ratio of LH/FSH，the relationship between different GnRH-analogues and clinical outcome was discussed. Results:The total number of Gn in LH/FSH≥2 group was less than that in LH/FSH<2 group (P<0.05). There was no significant differences in embryo quality and clinical outcome； the length of stimulation and the dose of gonadotropin were significantly less in GnRH antagonist group than in GnRH agonist long protocol group under the premise of LH/FSH≥2(P<0.05)； the number of retrieval oocytes, normal-fertilized oocytes，normal-cleavage oocytes and high quality embryos were better than the GnRH agonist long protocol group (P>0.05). Conclusion: The day-3 LH/FSH ratio of PCOS patients with 2 as the critical value may not have significant effects on embryo quality and clinical outcomes, and the clinical outcomes of LH/FSH≥2 in patients with polycystic ovary syndrome GnRH antagonist scheme significantly outperforms the GnRH agonist long protocol.