| Background:As we all know, the polycystic ovary syndrome (PCOS) is a kind of complex syndrome, which is diagnosed on the basis of hyperandrogenism, oligo-ovulation associated with oligomenorrhea, and polycystic ovaries on ultrasonography, is one of the most common reasons of unovulatory infertility. The prevalence of PCOS in women of reproductive age is about 6-10%, and even more individuals (up to 50%) in patients underwent ART treatment. Around 70%-80% cases would achieve clinical pregnancy after controlled ovarian hyperstimulation (COH). In vitro fertilization and embryo transfer (IVF-ET) and/or intracytoplasmic sperm injection and embryo transfer (ICSI-ET) was suggested for PCOS patients who ① succeeded to ovulate but failed to get pregnancy after 6 standard COH cycles; ②eagerly look forward to pregnancy after more than two drugs combined treatment; ③ combined with oviduct and/or male factors which will affect fertility. Since the syndrome is a complex reproductive-metabolic disorder, PCOS patients undergoing IVF-ET/ICSI-ET treatment shows drawbacks, including overall poor efficacy, more follicles retrieved but lower fertilization rate, and also ovarian hyperstimulation syndrome (OHSS). Recently, GnRH-a, GnRH-ant and mild-stimulation COH protocol was used in PCOS patients, many of these trials have tried to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment, however, research on big data is insufficient.Objective:In this retrospective study, the destination is to figure out the differences in application of drugs, number of follicle retrieved, occurrence of complication and pregnancy rate between different COH protocols in the case of 2064 patients with PCOS from 2011 to 2013. Finally, we hope to find a more suitable protocol for PCOS patients and provide individual therapy instruction for patients.Methods:A total of 2064 patients who underwent the IVF/ICSI-ET cycle at the Reproductive Hospital Affiliated to Shandong University between 2011 and 2013 were retrospective reviewed in the study. All of these patients were grouped into five groups according to different COH protocols. Group A:long protocol of GnRH-agonist (1821 cycles). Group B:short protocol of GnRH-agonist (89 cycles). Group C:small dose Gn and GnRH-antagonist (77 cycles). Group D:Clomiphene citrate or Letrozole tablet and/or GnRH-antagonist (41 cycles). Group E:prolonged protocol of GnRH-agonist (36 cycles).Results:The total dosage of gonadotrophins used in group E was more than that in other groups, the Gn started dosage of group C were significantly lower while the days of COH in group E were shorter than other groups (P<0.05). There was no significant difference in the number of embryo transferred, the number of frozen embryos, clinical pregnancy rate, OHSS incidence and abortion rate among each groups (P>0.05), although the oocytes retrieved in group E were significantly more and the same clinical index in group C was significantly less than that in other groups (P<0.01). No ectopic pregnancy happened in group C and group E, and ectopic pregnancy rate between group A and group D was similar (P<0.05).Conclusions:The present study suggests that the small dose Gn and GnRH-anyagonist protocol is recommended for patients with PCOS undergoing IVE-ET or ICSI-ET. |
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