7043个体外培养-胚胎移植助孕周期中新鲜胚胎移植周期与全胚冷冻后首次冻融胚胎移植周期分析

Analysis on outcomes between fresh embryo transfer cycles and frozen all-thawed embryo transfer cycles in 7043 in vitro fertilization cycles

目的:比较体外受精-胚胎移植(in vitro fertilization,IVF-ET)助孕中,新鲜胚胎移植周期与全胚冷冻后首次冻融胚胎移植周期的助孕结局,以探讨全胚冷冻策略是否可以在临床常规开展。方法:回顾性分析2016年1月至2016年12月在我院接受IVF/ICSI/FET助孕的7 043个胚胎移植周期。患者根据移植胚胎来源分为2组:新鲜胚胎移植周期(ovum pick up-embryo transfer,OPU-ET)组,采卵周期行新鲜胚胎移植,共3 353个周期;冻融胚胎移植组,取消新鲜胚胎移植,行全胚冷冻后首次冻融胚胎移植,共3 690个周期;比较2组间重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率,临床妊娠率、着床率、生化/临床妊娠流产率、异位妊娠率等。结果:冻融胚胎移植组平均年龄明显低于OPU-ET组[(30.66±4.16)vs.(31.78±4.39),P<0.05],但2组临床妊娠率比较无统计学差异[55.77%(2 058/3 690)vs. 55.41%(1 858/3 353),P=0.760];OPU-ET组重度OHSS发生率、异位妊娠率分别为2.54%(85/3 353)、5.22%(97/1 858),均高于冻融胚胎移植组(P<0.05),但生化妊娠流产率低于冻融胚胎移植组,差异有统计学意义[11.82%(249/2 107)vs. 13.86%(331/2 389),P=0.040]。结论:冻融胚胎移植可以明显降低异位妊娠率及重度OHSS发生率,但临床妊娠率无明显增高且生化妊娠流产率高于鲜胚移植周期,总体助孕结局无明显优势,建议仅对不适宜行新鲜胚胎移植的患者开展全胚冷冻策略。

Objective:To compare the in vitro fertilization(IVF) outcomes between fresh embryo transfer cycles and frozen all-thawed embryo transfer cycles and to evaluate the benefits of the “freeze-all” embryo strategy. Methods:A total of 7 043 embryo-transfer cycles performed from January 2016 to December 2016 in women aged less than 37 years were enrolled. Patients were divided into two groups:3 353 fresh embryo-transfer cycles and 3 690 frozen all-thawed embryo transfer cycles. The demographic characteristics,biochemical /clinical pregnancy abortion rate,clinical pregnancy rate,ovarian hyperstimulation syndrome(OHSS) rate were compared between the two groups. Results:Although the patients receiving frozen all-thawed embryo transfer cycles had a significantly younger age than those having fresh embryo transfer cycles[(30.66±4.16) vs. (31.78±4.39) years,P<0.05],no significant difference was found in the clinical pregnancy rate(55.77% vs. 55.41%,P=0.760) between the two groups. The incidence of severe ovarian hyper-stimulation syndrome was significantly higher in patients with fresh embryo transfer(P<0.05),but the biochemical pregnancy abortion rat was significantly lower compared with the frozen all-thawed embryo transfer cycles. Conclusion:The fresh embryo-transfer cycle has the similar pregnancy outcome with those of frozen all-thawed embryo transfer cycle. Our results support that only the patients who can’t receive fresh embryo transfer are suitable for the “freeze-all” embryo strategy.