年轻女性长方案获卵数与临床结局的关系

Analysis of optimal number of oocytes on clinical outcomes of young women with long protocol in IVF treatment

目的：探讨年轻、卵巢储备正常女性黄体期长方案中最佳获卵数范围，以取得最佳的临床结局。方法：回顾性分析首次接受体外受精．胚胎移植（IVF—ET）且卵巢储备正常的1526例患者的临床资料。根据获卵数不同分为5组：A组什。6枚）、B组（7-9枚）、C组（10-12枚）、D组（13~15枚）、E组（≥16枚），比较各组的受精率、卵裂率、种植率、可移植胚胎数、早期流产率、临床妊娠率及活产率、因卵巢过度刺激综合征（OHSS）倾向全部胚胎冷冻率、无可利用胚胎取消周期率和累积妊娠率及活产率等。结果：①各组受精率、卵裂率、无可利用胚胎取消率、种植率及早期流产率无统计学差异∽〉0．05）。新鲜周期移植临床妊娠率及活产率c组最高，但差异无统计学意义（P〉0．05）。②随着获卵数的增加，可利用胚胎数增加，因OHSS倾向全部胚胎冷冻率显著增加。可利用胚胎率E组显著低于其他4组，D组显著低于B组（P〈0．05）。累积妊娠率及累积活产率A组显著低于C组、D组及E组，B组显著低于E组，差异均具有统计学意义（P〈0．05）。③E组全部胚胎冷冻后首次复融移植临床妊娠率显著高于新鲜移植周期（p=0．05）。结论：行黄体期长方案促排卵的年轻患者，获卵数为10~12枚时，在获得理想妊娠结局的同时，能够降低OHSS的风险，是理想的获卵数范围。当获卵数≥16枚时，全部胚胎冷冻后择期行复融移植能够取得更理想的临床结局。

Objective： To investigate the association between oocyte number and clinical outcomes of young infertility women undergoing long protocol during in vitro fertilization （IVF） cycles. Methods： The data of 1 526 infertile women undergoing their first IVF treatment cycle of long protocol were collected retrospectively. Patients were divided into five groups based on retrieval oocyte number： group A （4-6）, group B （7-9）, group C （10-12）, group D （13-15）, group E （≥16）. The general clinical characteristics and clinical outcomes of IVF were compared. Results： 1） There were no significant differences in fertilization rate, cleavage rate, cancellation rate, pregnancy rate, implantation rate, early miscarriage rate and live birth rate among five groups （P〉0.05）. However, group C had the highest clinical pregnancy rate and live birth rate in fresh cycle. 2） With the increase of oocyte retrieved, the number of transferrable embryos and OHSS risk increased significantly. The transferrable embryo rate of group E was lower than that in the other four groups and in group D it was lower than that in group B. Also, group A had the lowest cumulative pregnancy rate and cumulative live birth rate, which in group B were lower than those in group E （P〈0.05）. 3） The clinical pregnancy rate in the first frozen-thawed embryo transfer cycle was much higher than fresh cycle in group E. Conclusion： For young infertile women undergoing long protocol in IVF, 10-12 oocytes is an ideal range of oocyte number to obtain the optimized pregnancy outcomes and a balance the OHSS risk. When the No. of retrieval oocyte is ≥ 16, frozen-thawed embryo transfer may improve the pregnancy rate.