卵巢过度刺激综合征高风险及胚胎冷冻保存时间对全胚冷冻第一移植周期围产期结局的影响

The effects of high risk of ovarian hyperstimulation syndrome and duration of embryo cryopreservation on perinatal outcomes of single live births in the first frozen embryo transfer cycle after whole embryo cryopreservation

目的分析卵巢过度刺激综合征(OHSS)高风险及胚胎冷冻保存时间对全胚冷冻第一移植周期围产期结局的影响。方法回顾性分析2016年1月到2021年6月于郑州大学第三附属医院生殖医学中心行全胚冷冻第一周期单胚胎移植且取得单胎活产的1804例患者的临床资料。根据取卵周期有无OHSS高风险分为高风险组(n=790)和非高风险组(n=1014),比较2组患者基线数据和围产期结局的差异,采用多因素线性回归分析新生儿出生体重的相关因素。根据胚胎冷冻保存时间不同将高风险组分为3个亚组:冷冻保存时间<60 d的96个周期为A组,冷冻保存时间60~120 d的587个周期为B组,冷冻保存时间>120 d的107个周期为C组;比较3组围产期结局的差异。本研究计量资料采用[M(Q_(1),Q_(3))]表示。结果高风险组女方年龄为30.0(27.0,32.0)岁,低于非高风险组的31.0(29.0,34.0)岁(P<0.001)。高风险组男方年龄为30.0(28.0,33.0)岁,低于非高风险组的32.0(29.0,35.0)岁(P<0.001)。高风险组新生儿出生体重[3500.0(3200.0,3800.0)g]高于非高风险组[3400.0(3150.0,3800.0)g](P=0.045)。多因素线性回归分析结果显示,女性BMI与新生儿出生体重相关,β值(95%CI)为15.37(8.33,22.41),P<0.001,OHSS高风险与新生儿出生体重不相关,β值(95%CI)为19.40(-38.07,76.87),P=0.508。A、B、C 3组间新生儿低出生体重、极低出生体重发生率的差异具有统计学意义(均P<0.05),其中C组低出生体重儿、极低出生体重儿发生率高于B组(均P<0.017)。结论行全胚冷冻第一周期移植的OHSS高风险患者不良围产期结局并未增加,但胚胎冷冻保存时间过长,可能导致新生儿低出生体重、极低出生体重风险增加。

Objective To investigate the effects of high risk of ovarian hyperstimulation syndrome(OHSS)and duration of embryo cryopreservation on perinatal outcomes of the first frozen‑thawed cycle after whole embryo cryopreservation.Methods The clinical data of 1804 patients who underwent the first frozen‑thawed cycle after whole embryo cryopreservation and achieved singleton live births in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed.According to whether there was high risk of OHSS in the oocyte retrieval cycle,the patients were divided into high‑risk group(n=790)and non‑high‑risk group(n=1014).The baseline data and perinatal outcomes were compared between the two groups.Multivariate linear regression was applied to analyze the relative factors affecting neonatal weight.And the high‑risk group was divided into three subgroups according to different cryopreservation time:the embryos of 96 cycles with a cryopreservation time less than 60 days were defined as group A;the embryos of 587 cycles with a cryopreservation time around 60 to 120 days were defined as group B;the embryos of 107 cycles with a cryopreservation time more than 120 days were defined as group C.The perinatal outcomes were compared among the three groups.The measurement data in this study were represented by[M(Q_(1),Q_(3))].Results The female age in the high‑risk group was 30.0(27.0,32.0)years old,which was lower than that in the non‑high‑risk group 31.0(29.0,34.0)(P<0.001).The male age in high‑risk group was 30.0(28.0,33.0),lower than that in non‑high‑risk group 32.0(29.0,35.0)(P<0.001).The birth weight of high‑risk group[3500.0(3200.0,3800.0)g]was higher than that of control group[3400.0(3150.0,3800.0)g](P=0.045).Multivariate linear regression analysis showed that female BMI was correlated with neonatal weight,β(95%CI)was 15.37(8.33,22.41)(P<0.001),and the high risk of OHSS was not correlated with neonatal weight,β(95%CI)was 19.40(-38.07,76.87)(P=0.508).There was significant difference in the incidence of low birth weight and very low birth weight among groups A,B and C(all P values<0.05),and the incidence of low birth weight and very low birth weight in group C was higher than that in group B(all P values<0.017).Conclusions The risk of adverse perinatal outcomes in high‑risk OHSS patients who underwent the first frozen‑thawed cycle after whole embryo cryopreservation was not increased.However,prolonged cryopreservation of embryos may lead to increased risk of low birth weight and very low birth weight.