胰岛素释放试验异常对PCOS患者IVF/ICSI结局的预测作用

摘要

目的 探讨胰岛素释放试验异常对多囊卵巢综合征(PCOS)患者体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局的预测作用.方法 选取就诊于青岛市妇女儿童医院生殖中心行助孕治疗的PCOS患者119例,所有入组的PCOS患者均行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验.根据胰岛素释放试验将PCOS患者分为两组,胰岛素释放试验正常组50例(空腹胰岛素为3.0~25.0 mU/L,2 h胰岛素低于1 h胰岛素,血胰岛素<200 mU/L),胰岛素释放试验异常组69例.比较2组患者临床结局.结果 胰岛素释放试验正常组双原核(2PN)数、优质胚胎数及鲜胚移植时生化妊娠率、胚胎种植率、临床妊娠率明显高于胰岛素释放试验异常组,差异有统计学意义(P<0.05).胰岛素释放试验正常组患者获卵数、成熟卵数有高于胰岛素释放试验异常组的趋势,胰岛素释放试验正常组患者早期流产率有低于胰岛素释放试验异常组的趋势,但差异均无统计学意义(P>0.05).结论 胰岛素释放试验可以作为预测PCOS患者IVF/ICSI-ET妊娠结局的良好指标.胰岛素释放试验异常对PCOS患者IVF/ICSI-ET妊娠结局造成不利影响,对于此类患者在进行助孕治疗前最好给予预处理以改善其妊娠结局.%Objective:To study the prediction effect of insulin release test abnormality on IVF/ICSI-ET outcome in patients with polycystic ovary syndrome (PCOS).Methods:One hundred and nineteen patients with PCOS undergone assisted reproduction treatment were collected in the Reproductive Center of Qingdao Women and Children Hospital.All the patients experienced oral glucose tolerance test and insulin release test.According to insulin release test (the normal range is fasting insulin 3.0-25.0 mU/L,2 hours insulin less than 1 hour insulin,blood insulin<200 mU/L),the patients were divided into two groups:insulin release test normal group (n=50),abnormal insulin release test group (n=69).The clinical outcomes of the two groups were compared.Results:The 2PN number,high quality embryo number,biochemical pregnancy rate in fresh embryo transplantation,embryo implantation rate,clinical pregnancy rate in normal group were significantly higher than abnormal insulin release test group (P<0.05).The number of oocytes retrieved,number of mature oocytes in insulin release test normal group were higher and the early abortion rate was lower than the abnormal insulin release test group,but there were no significant differences (P>0.05).Conclusions:Insulin release test can be used as a good predictor for pregnant outcome of IVF/ICSI-ET in patients with PCOS.Insulin release test abnormality impacts adverse effect on pregnancy outcomes in patients with PCOS.For such patients,it is advisable to do insulin release test before IVF treatment to improve their pregnancy outcomes.