全胚冷冻后行FET避免IVF/ICSI—ET助孕治疗中、重度OHSS发生风险

Application of frozen embryo transfer after all embryos cryopreservation to prevent moderate and severe OHSS occurring in IVF/ICSI-ET treatment

目的比较对于体外受精/胞浆内单精子注射—胚胎移植(IVF/ICSI-ET)助孕后有OHSS高风险患者进行鲜胚移植或取消鲜胚移植行全胚冷冻、冻胚移植两种不同处理方式对助孕结局的影响。方法回顾性分析2010年1～12月在该院生殖中心接受IVF/ICSI-ET助孕存在OHSS发生高风险的共1 578例患者临床资料,比较行鲜胚移植或取消移植行全胚冷冻后冻胚移植(FET)两种不同处理方式所获得的妊娠结局及处理后OHSS发生率。结果 2010年鲜胚移植共计9 009周期,OHSS高风险患者共计1 578周期(E2≥4 000pg/mL或取卵数≥30个)。OHSS高风险患者进行鲜胚移植为1 284周期,其临床妊娠率为60.9%;全胚冻存294周期,行首次FET为250周期,临床妊娠率54.0%(P<0.05);两组的着床率分别为39.7%(1111/2 802)和35.7%(185/518),流产率分别为9.7%(76/782)和8.9%(12/135)。OHSS高风险患者进行鲜胚移植后发生重度OHSS共46周期,其发生率为3.6%(46/1 284),高于全胚冷冻组0.3%(1/294),亦高于全年度非OHSS高风险鲜胚移植患者的1.3%(100/7 725周期)(P<0.05)。结论 OHSS高风险患者进行全胚冷冻后冻胚移植首周期较鲜胚移植能有效避免重度OHSS的发生。

[ Objective ] To compare the outcome between fresh embryo transfer and frozen embryo transfer after freezing all embryos in women with high risk of ovary hyperstimulation syndrome （OHSS） in vitro fertilization/intracytoplasmic sperm injection-embryo transfer 0VF/ICSI-ET） treatment. [ Methods] A retrospective analysis of 1 578 patients with high risk of OHSS in IVF/ICSI-ET treatment cycle from June 2010 to December 2010 in our hospital was made. The patients were divided into two groups： control group performed continued fresh embryo transfer, the other group conducted all embryos frozen followed by frozen embryo transfer the next cycle. Clinical pregnancy rate and occurrence rates of varying degree of OHSS were compared. [ Results ] There were 9 009 cycles in the year of 2010 and 1 578 cycles with high risk of OHSS （E2≥4 000 pg/mL or retrieved oocytes more than 30）. The pregnancy rate of fresh embryo transfer group was 60.9% （782/1 284）. There were 294 cycles in frozen all embryos, and 250 cycles conducted their first frozen embryo transfer. The pregnancy rate of this grout） was 54.0% （135/250） The implantation rates of the two groups were 39.7% （1 111/2 802） and 35.7% （185/518）, respectively. The abortion rates of two groups were 9.7% （76/782） and 8.9% （12/135） respectively. The severe OHSS rate of fresh embryo transfer group （3.6%, 46/1 284） was significant higher than freeze-all group （0.3%, 1/294）, and also higher than those patients of low risk of OHSS （1.3%, 100/7 725, P 〈0.05）. [ Conclusion] Frozen embryo transfer after all embryos eryopreservation in women with high risk of OHSS can avoid the occurrence of severe OHSS effectively compared with directly transfer fresh embryos.