冻胚移植与鲜胚移植在OHSS高危患者中应用的临床结局分析

Clinical outcomes of fresh versus cryopreserved-thawed embryo transfer in high-risk patients with ovarian hyperstimulation syndrome

目的:比较鲜胚移植与冻胚移植在卵巢过度刺激综合征(OHSS)高危患者中应用的临床结局。方法:回顾性分析2012年1月至2013年12月在本中心进行体外受精的OHSS高危患者1 784例。选择OHSS高危参与鲜胚移植组939例,为A组;选择OHSS高危放弃鲜胚移植后行冻融胚胎移植组845例,为B组。分析两组患者的的Gn用量、体重指数、多囊卵巢综合征(PCOS)比例,获卵数、妊娠率及胚胎种植率。结果:A组患者,939例,行鲜胚移植,临床妊娠657例,妊娠率69.97%,发生中度OHSS 33例,占3.5%。B组患者,845例,为预防OHSS放弃鲜胚移植,将全胚胎冷冻,发生中度OHSS 30例,占3.6%,后行冻融胚胎移植,临床妊娠586例,妊娠率69.35%。A组患者PCOS发生率、注射人绒毛膜促性腺激素(h CG)日雌激素(E2)水平、获卵数、成熟卵子数、优质胚胎数均显著低于B组(P<0.01);两组患者的年龄、不孕年限、体重指数、Gn天数、Gn用量、胚胎种植率、临床妊娠率、流产率以及OHSS发生率差异均无统计学意义(P>0.05)。结论:在体外受精-胚胎移植中,OHSS高危患者放弃鲜胚移植后行冻融胚胎移植,可获得与鲜胚移植相同的临床妊娠率,且通过放弃鲜胚移植可避免更多、更严重的OHSS发生。

Objective： To compare the clinical outcomes of fresh embryo transfer and cryopreserved-thawed embryo transfer in high-risk patients with ovarian hyperstimulation syndrome（ OHSS）. Methods： We retrospectively analyzed the clinical data of 1784high-risk OHSS patients undergoing IVF-ET,who were divided into groups A（ n = 939） and B（ n = 845）. The former received fresh embryo transfer and the latter cryopreserved-thawed embryo transfer. We compared gonadotropin（ Gn） administration,body mass index（ BMI）,the prevalence of polycystic ovary syndrome（ PCOS）,the number of oocytes retrieved,and the rates of clinical pregnancy,embryo implantation and OHSS incidnece between the two groups. Results： Totally,657（ 69. 97%） and 586（ 69. 35%） pregnancies were achieved in groups A and B,respectively,with 33 cases of moderate OHSS（ 3. 5%） in the former and 30（ 3. 6%） in the latter. The prevalence of PCOS,the E2 level at h CG trigger,the number of oocytes retrieved,the number of mature oocytes,and the number of quality embryos were significantly lower in group A than in B（ P 〈0. 01）. No statistically significant differences were found between the two groups in age,infertility duration,BMI,Gn administration,embryo implantation rate,clinical pregnancy rate,abortion rate,and OHSS incidence（ P 〉0. 05）. Conclusion： In IVF-ET cycles,cryopreserved-thawed embryo transfer does not influence the clinical outcome in high-risk OHSS patients and can avoid the incidence of severe OHSS.