肥胖多囊性卵巢症候群試管嬰兒新療法 pco ultra-long agonist (ULA) protocol

2014.06.07

 肥胖多囊性卵巢症候群試管嬰兒新療法 pco     ultra-long agonist (ULA) protocol

 
我們常遇到多囊性卵巢症候群的試管嬰兒患者有過度肥胖的情形，打排卵針要怎麼打實在需要有點技巧，因為她們打針的卵巢反應會比較慢，到底要打長療程？還是短療程好呢？
 
有一份來自於2014年《婦產科內分泌雜誌》的研究，針對499名肥胖多囊卵巢病人、BMI超過25的多囊性卵巢症候群患者，將她們的試管嬰兒療程從長療程調整為超長療程ULP  ultra-long agonist (ULA) protocol。所謂的超長療程是指，進入試管嬰兒療程前的前一個月月經來潮時，打一支長效柳菩林迪波，等下個月月經來時開始打排卵針。
 
他們發現超長療程ULP懷孕率有70.2％，反觀LP長療程為50.8％，所以他們認為患有肥胖的多囊性卵巢症候群患者，就乾脆在療程前一個月的月經來時打長效柳菩林迪波，這樣可以取得較高的懷孕率，懷孕率有70.2％是相當了不起的成績。
 
Gynecol Endocrinol. 2014 Mar;30(3):209-12. doi: 10.3109/09513590.2013.860121. Epub 2013 Dec 19.
A novel modified ultra-long agonist protocol improves the outcome of high body mass index women with polycystic ovary syndrome undergoingIVF/ICSI.
Tu J1, Lin G, Lu C, Gong F.
Author information
 
Abstract
In an attempt to evaluate the effectiveness of a novel modified ultra-long agonist (ULA) protocol on polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI), a retrospective study of 499 women employed with either ULA or conventional long agonist (LA) protocol was analyzed. In high BMI group (>25 kg/m(2)), the ULA protocol yielded significant higher clinic pregnancy rate (PR) (70.2% versus 50.8%, p < 0.05), implantation rate (52.7% versus 35.7%, p < 0.05) and live birth rate (63.8% versus 39.0%, p < 0.05) when compared with LA protocol. In low BMI group (≤25 kg/m(2)), the ULA protocol also demonstrated a higher clinic PR (70.8% versus 59.5%, p < 0.05) whereas implantation rate and live birth rate are comparable. Within ULA protocol, the clinic PR, implantation rate and live birth rate are similar between high and low BMI patients. Similarly, the clinic PR and live birth rate demonstrated no significant difference within LA group but there is a significant lower implantation rate (35.7% versus 63.9%, p < 0.05) observed in high BMI patients. No difference in miscarriage rate and severe OHSS rate was found among all groups. In conclusion, ULA protocol benefits the IVFoutcomes of PCOS patients with high BMI status.