OHSS高风险全胚冷冻后FET时机对妊娠结局的影响

Effect of the timing of FET after whole embryo freezing due to high risk of OHSS in patients received IVF/ICSI

目的探讨OHSS高风险患者全胚冷冻后冻融胚胎移植(FET)的时机。方法回顾性分析2014年6月至2018年12月于西北妇女儿童医院生殖中心接受IVF/ICSI-ET治疗,因OHSS高风险而全胚冷冻的患者共2060例。根据取卵日距第1次FET日的时间长短分为两组:时间间隔≤40 d为立即FET组,共196例;时间间隔>40 d为延迟FET组,共1864例。对比分析两组间的妊娠结局及新生儿体重。结果两组间女方年龄、BMI、不孕类型及不孕年限、Gn总量、优质胚胎数、扳机日雌激素水平等基线资料的差异均无统计学意义(P>0.05);两组间胚胎种植率、临床妊娠率、流产率、活产率、早产率、单胎及双胎新生儿出生体重、异常出生体重发生率等指标差异均无统计学意义(P>0.05);Logistic回归分析显示,延迟FET对活产率、胚胎种植率、临床妊娠率、流产率无显著性影响(P>0.05)。调整影响妊娠结局的混杂因素,包括女方年龄、女方BMI、移植胚胎个数及移植胚胎类型后,延迟FET对活产率[OR=1.104,95%CI(0.813,1.502),P=0.536]、胚胎种植率[OR=0.907,95%CI(0.641,1.283),P=0.569]、临床妊娠率[OR=0.892,95%CI(0.634,1.275),P=0.529]、流产率[OR=0.924,95%CI(0.575,1.496),P=0.750]的影响仍不显著。两组新生儿出生体重及异常体重新生儿的发生率间差异无统计学意义(P>0.05)。结论因OHSS高风险而全胚冷冻患者,取卵术后首次月经来潮即可开始准备内膜进行FET,延迟FET并不能改善妊娠结局。

Objective:To explore the timing of FET after whole embryo freezing due to the high risk of OHSS.Methods:The data of 2060 patients who received IVF/ICSI-ET treatment in the Assisted Reproductive Medicine Center,Northwest Women’s&Children’s Hospital from June 2014 to December 2018 were retrospectively analyzed.According to the time length between the oocyte retrieval and the embryo transfer of the first FET cycle,they were divided into two groups:≤40 days in the immediate FET group(n=196)and>40 days in the delayed FET group(n=1864).The pregnancy outcome and newborn weight were compared between the two groups.Results:There were no significant differences in baseline data such as the female age,BMI,the type and duration of infertility,the total doses of Gn,the number of high-quality embryos,and the estradiol level on trigger day between the two groups(P>0.05).There were no significant differences in embryo implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate,preterm birth rate,birth weight of single and twin newborns,and incidence of abnormal newborn weight between the two groups(P>0.05).Logistic regression analysis showed that delayed FET had no significant effects on live birth rate,embryo implantation rate,clinical pregnancy rate,and abortion rate(P>0.05).After adjusting the confounding factors including female age,BMI,the number of embryos transfer and the type of embryos transfer,delayed FET still had no significant effects on live birth rate[OR=1.104,95%CI(0.813,1.502),P=0.536],embryo implantation rate[OR=0.907,95%CI(0.641,1.283),P=0.569],clinical pregnancy rate[OR=0.892,95%CI(0.634,1.275),P=0.529],abortion rate[OR=0.924,95%CI(0.575,1.496),P=0.750].There was no significant difference in newborn weight and the incidence of abnormal newborn weight between the two groups(P>0.05).Conclusions:Patients received the whole embryo freezing protocol can start FET cycle in the first menstrual period after oocyte retrieval.Delayed FET cannot improve the pregnancy outcome.