选择性单胚胎移植应用于OHSS倾向患者的初探

A Pilot Study on the Application of Elective Single Embryo Transfer on the OHSS Risk Patients

目的:探讨在IVF-ET过程中出现卵巢过渡刺激综合征(OHSS)倾向的患者实施选择性单胚胎移植的临床结局及对预防OHSS的作用。方法:将97例IVF-ET过程中出现OHSS风险的患者随机分为A组(n=59),进行择性单胚胎移植(eSET);B组(n=38),放弃本周期,实行全胚冷冻。比较A、B组患者中-重度OHSS的发生率及治疗情况,并计算eSET的临床指标。采用Logistic回归分析可能影响中-重度OHSS发生的原因;另外采用ROC曲线分析窦卵泡,取卵数与中-重度OHSS发生的关系。结果:A组(eSET)临床妊娠率为35.6%,胚胎种植率为35.6%,活产率为32.2%。A、B组中-重度OHSS住院率、平均住院天数、治疗情况、胸水发生率无统计学差异(P>0.05)。但在发生OHSS病例中,妊娠组平均住院天数增加、腹腔穿刺比例与非妊娠者比较明显增加(P<0.05);进入Logistic回归模型的危险因素为窦卵泡(OR=1.57,95%CI=1.18～2.09)及取卵数(OR=1.57,95%CI=1.02～1.47),P均<0.05,均为危险因素;窦卵泡与取卵数预测OHSS发生率的曲线下面积(AUC)分别为0.81(95%CI=0.68～0.93)和0.69(95%CI=0.57～0.82)。依据ROC曲线提示当窦卵泡数>15个和取卵数>22个时发生中-重度OHSS的可能性较大。结论:选择性单胚胎移植对于IVF过程中出现OHSS风险倾向的患者不失是一种选择,既保证了本周期一定的妊娠率,也没有明显增加中-重度OHSS的发生风险,但临床妊娠者可能病程较长、病情较严重。

Objective： To investigate the clinical outcome of elective single embryo transfer（eSET） applied in the patients who have ovarianhyperstimulationsyndrome（OHSS） risk during the IVF treatment,and its effect on the OHSS severity.Methods： A total of 97 patients were recruited as retrospective analysis,and were randomly divided into two groups.Group A（n= 59）took eSET,group B（n= 38） choose crypreserve all the embryos,the occurrence of severe OHSS and its severity were compared between two groups,the outcome of moderateor eSET were measured.The risk factors of severe OHSS were analyzed by using logistic regression analysis.The correlation of antral follicle count（AFC）,no.of oocytes with the occurrence of moderateor-severe OHSS was analyzed by ROC curve.Results： The pregnancy rate,implantation rate and live birth rate of the group A was 35.6%,35.6%,32.2%,respectively.The occurrence of severe OHSS,hospitalization days and the use of albumin and abdominal puncture rate were no difference between two groups（P〉0.05）.However when compared pregnant and nonpregnant patients who have OHSS,hospitalization days were longer and chances of abdominal puncture were much higher in pregnant patients（P〈0.05）.AFC（OR=1.57,95%CI=1.18-2.09） and number of oocytes obtained（OR= 1.57,95%CI=1.02-1.47） were finally entered in the logistic regression model,the areas under ROC curve（AUC） of AFC and number of oocytes obtained for predicting the severe OHSS were 0.81（95%CI=0.68-0.93） and 0.69（95%CI=0.57-0.82）.The cutoff value of AFC and number of oocytes obtained were 15 and 22,indicate when AFC15,oocytes obtained〉22,the chance of having moderateor-severe OHSS were higher.Conclusion： Single embryo transfer is a method alternative to crypreserve all the embryos,when the patient have OHSS risk,which seems not increase the chanced of severe OHSS,and can get acceptable pregnancy rate in the fresh cycle.However,if pregnant,it may become severer.eSET will get more acceptable and wildly used in the near future.