预防OHSS行全胚冷冻的临床研究

Clinical research of all embryo freezing to prevent OHSS

目的探讨在辅助生育技术过程中出现卵巢过度刺激综合征(OHSS)倾向患者进行全胚冷冻,以预防OHSS发生,后进行冷冻胚胎移植的应用价值。方法选择2009年1月至2010年12月在本中心进行ART患者,共取卵1722周期,其中具有OHSS倾向患者201周期,占总取卵周期的11.67%,分极高危OHSS倾向组和高危OHSS倾向组两组。极高危OHSS倾向组给予全部胚胎冷冻,以后再安排冷冻胚胎移植,对于高危OHSS倾向组给予新鲜胚胎移植。比较促排卵药的使用总量及使用天数、HCG日E2水平、平均获卵数、平均胚胎数、平均优质胚胎数、OHSS发生率情况。比较全部胚胎冷冻进行复苏后移植与新鲜胚胎移植比较平均移植胚胎数、平均移植优质胚胎数、妊娠率、着床率、早期流产率等。结果1.两组患者的平均年龄、不孕年限、促排卵药的使用总量和天数无显著性差异;但全胚冷冻组HCG日E2水平、平均获卵数、平均胚胎数、平均优质胚胎数及OHSS发生率均高于新鲜周期移植组。2.全胚冷冻后行冷冻胚胎移植组与新鲜周期移植组的平均移植胚胎数、平均移植优质胚胎数、妊娠率、着床率、早期流产率均无显著性差异。结论 1.全胚冷冻不能减少早发型OHSS发生;2.为预防OHSS行全胎冷冻后,再行冷冻胚移植不影响不孕症患者治疗结局。

Objeetive ： To explore utilisation of elective eryopreservation of all embryos for the patients at high risk of ovarian hyperstimulation syndrome （OHSS） to prevent OHSS in assisted reproduetion therapy （ART）, and report on reproductive outcome following transfer of thawed embryos. Methods ： A retrospective analysis of all ART eyeles earried out between January 2009 and December 2010. 1722 ooeyte retrievals were performed, all high risk for OHSS from 201 retrievals （ 11.67% ） were divided into critical or severe risk OHSS group. All embryos were eleetively eryopreserved and embryo transfer was postponed in critical OHSS group. Fresh embryo transfer was performed in severe risk OHSS group. Total dose of Gn, duration of Gn stimulation, serum E2 of hCG day, Ooeytes retrieved, number of embryos, good quality embryos and OHSS rate were eompared between critical or severe risk OHSS group. Number of embryos transferred, good quality embryos for embryos transferred, elinieal pregnancy rate, implantation rate and early pregnancy loss rate were compared between fresh embryo transfers and frozen embryo transfers group. Results： There were no significant difference in female age, duration of infertility, total dose of Gn, duration of Gn stimulation for both groups. Serum E2 of hCG day. Ooeytes retrieved, number of embryos, good quality embryos and OHSS rate were significant higher in all embryos eryopreserved group. There were no signifieant differenee in number of embryos transferred, good quality embryos for embryos transferred, elinieal pregnancy rate, implantation rate and early pregnancy loss rate. Conelusions： 1. Cryopreservation of all embryos didn＇t prevent early OHSS. 2. Cryopreservation of all embryos and frozen embryo transfer didn＇ t influence the treatment resuhs in infertile patients.