Objective: To investigate the impact of dyslipidemia on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) pregnancy outcome in patients with polycystic ovary syndrome (PCOS) . Methods: From July 2013 to March 2016, 468 PCOS patients with antagonist protocol in IVF/ICSI of First Affiliated Hospital of Nanjing Medical University, cycles were divided into dyslipidemia group (108 cases) and normol blood lipids group (360 cases) according to the serum cholesterol, triglyceride (TG) , high-density lipoprotein, low density lipoprotein levels. The general condition and clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, clinical pregnancy rate, live birth rate and the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS) , etc. Besides, stratified analysis and multivariate logistic regression analysis were used to correct the impact of body mass index (BMI) . Results: (1) Comparing the based data of dyslipidemia group and normal blood lipids group: age, years of infertility, basic FSH, basic LH, basic estradiol and other indexes had no significant differences (all P>0.05) , but BMI of dyslipidemia group was significantly higher than normal blood lipids group [ (25.0±3.0) versus (23.1±3.0) kg/m(2)], difference had statistical significance (P<0.01) . (2) The high score embryo rate, endometrial thickness on the day of hCG injection, progesterone and LH levels on the day of hCG injection, moderate to severe OHSS rate and miscarriage rate in the two groups did not exhibit remarkable differences (all P>0.05) . However, the number of dominant follicle, retrieved oocyte number, estrogen level on the day of hCG injection, implantation rate, biochemical pregnancy rate, clinical pregnancy rate and the live birth rate in dyslipidemia group were significantly less than those of normal blood lipids group (all P<0.05) , the dose of gonadotropin (Gn) and days of stimulation were significantly higher compared with the normal blood lipids group, there were significant differences statistically (all P<0.05) . (3) Stratified analysis showed that no matter in BMI<24 or BMI≥24 kg/m(2) group, the dose of Gn and days of stimulation were significantly higher in the dyslipidemia group than those of the normal blood lipids group, the difference was statistically significant (P<0.05) . However, the number of oocytes retrieved, estrogen level on the day of hCG injection had obvious downtrend, and the difference was statistically significant (P<0.05) in BMI≥24 kg/m(2) group. Multivariate logistic regression analysis found that, even after the correction of BMI, dyslipidemia still had negative impact on implantation rate, biochemical pregnancy rate, clinical pregnancy rate and the live birth rate (P<0.05) . (4) Further analysis of the different components of blood lipids in the clinical pregnancy group and unobtained pregnancy group revealed that the level of triglyceride (TG) in the unobtained pregnancy group was significantly higher than that in the pregnancy group, and the difference was statistically significant (P<0.05) ; logistic regression analysis also showed that the increase of TG levels was negatively correlated with the clinical pregnancy rate of PCOS patients (P<0.05) . Conclusions: PCOS patients combined with dyslipidemia have a higher BMI, and dyslipidemia increases the dosage of Gn, reduces the implantation rate, clinical pregnancy rate and live birth rate, especially the increase of TG level,which has adverse effects on IVF/ICSI outcome in patients with PCOS.
目的： 探讨血脂异常对多囊卵巢综合征（PCOS）患者体外受精或卵母细胞胞质内单精子注射（IVF/ICSI）妊娠结局的影响。 方法： 选择南京医科大学第一附属医院2013年7月至2016年3月行IVF/ICSI、采用促性腺激素释放激素拮抗剂方案诱导排卵的PCOS不孕患者共468例，根据血清胆固醇、三酰甘油（TG）、高密度脂蛋白、低密度脂蛋白水平分为血脂异常组（108例）及血脂正常组（360例）。回顾性分析两组患者的一般情况及临床妊娠结局，并采用分层分析及多因素logistic回归分析校正体质指数（BMI）的影响。 结果： （1）血脂异常组与血脂正常组患者的基础资料：年龄、不孕年限、基础FSH、基础LH、基础雌激素水平等两组间比较均无差异（P>0.05），但血脂异常组患者的BMI显著高于血脂正常组，分别为（25.0±3.0）、（23.1±3.0）kg/m(2)，两组比较，差异有统计学意义（P<0.01）。（2）两组患者的高评分胚胎率、hCG日子宫内膜厚度、hCG日孕激素及LH水平、中重度卵巢过度刺激综合征发生率、流产率，分别比较，差异均无统计学意义（P>0.05）；血脂异常组患者的优势卵泡数、获卵数、hCG日雌激素水平、胚胎种植率、生化妊娠率、临床妊娠率、活产率均显著低于血脂正常组（P均<0.05），促性腺激素（Gn）使用总量、Gn使用天数显著高于血脂正常组（P<0.05）。（3）分层分析显示，无论在BMI<24 kg/m(2)还是BMI≥24 kg/m(2)，血脂异常组患者较血脂正常组，Gn使用总量、Gn使用天数均显著增高（P<0.05）；获卵数、hCG日雌激素水平有下降趋势，且在BMI≥24 kg/m(2)中两组有差异（P<0.05）；多因素logistic回归分析显示，即使校正了BMI，血脂异常仍然对胚胎种植率、生化妊娠率、临床妊娠率、活产率有负面影响（P<0.05）。（4）进一步分析临床妊娠者与未获得临床妊娠者的不同血脂组成成分显示，未获得临床妊娠者的TG水平显著高于妊娠者（P<0.05），logistic回归分析也显示，TG水平升高与PCOS患者的临床妊娠率负相关（P<0.05）。 结论： 血脂异常的PCOS患者具有更高的BMI，增加了Gn的用量，降低了患者的胚胎种植率、临床妊娠率及活产率，特别是TG水平升高，对PCOS患者的IVF/ICSI结局有不良影响。.
Keywords: Dyslipidemia; Fertilization in-vitro; Polycystic ovary syndrome; Pregnancy outcome; Sperm injections, intracytoplasmic.