中-重度卵巢过度刺激综合征的预测及其妊娠结局

Prediction and Pregnancy Outcomes of Moderate and Severe Ovarian Hyperstimulation Syndrome

目的探讨取卵数及注射HCG日血清E2值对中-重度OHSS发生的预测效能。方法选择2010年1月～2014年3月在浙江大学医学院附属妇产科医院行体外受精-胚胎移植周期中发生中-重度OHSS的患者338例，选择同期未发生OHSS并行鲜胚移植及取消鲜胚移植全胚冷冻后首次行FET的患者343例作为对照组，分析取卵数及注射HCG日血清E2值对OHSS的预测价值及判定最佳诊断界值点，探讨其妊娠结局。结果OHSS组患者取卵数及注射HCG日血清E2值均显著高于对照组。预测OHSS发生的HCG日血清E2值的最佳诊断界值点为14591pmol／L，取卵数为17．5个。OHSS组-鲜胚移植患者的临床妊娠率、活产率及双胎早产的发生率均显著高于对照组。OHSS组-冻胚移植患者与对照组比较，差异均无统计学意义（P〈0．05）。结论注射HCG日血清E2值及取卵数对中-重度OHSS的发生有一定的预测作用。对于OHSS高风险的患者，建议全胚冷冻后行冻胚移植，以减少OHSS的发生。

Objective To explore the predictive value of the number of retrieved oocytes and the estradiol （ E2） levels on the HCG day in moderate and severe OHSS patients. Methods The clinical data of 338 patients with moderate and severe OHSS receiving in vitro fertilization - embryo transfer and 343 control patients who had fresh embryo transfer cycles without OHSS and first frozen embryo transfer cycles after the whole - embryo freezing in Women＇s Hospital School of Medicine Zhejiang University from January 2010 to March 2014 were analyzed retrospectively. The predictive value and cut - off value of the number of retrieved oocytes and the E2 levels on the HCG day were analysed. The pregnancy outcomes were compared between the two groups. Results The number of retrieved oocytes and the E2 levels on the HCG day were higher than those in the control group. The cutoff value of E2 on the HCG day and the number of retrieved oocytes for moderate and severe OHSS were 14591pmo1/L and 17.5, respectively. The clinical pregnancy rate, live birth rate and the preterm birth rate of twin pregnancies in OHSS group - fresh embryo transfer were significantly higher than control group. There wss no significant difference between the OHSS group - frozen embryo transfer and control group in any parameter. Conclusion The number of retrieved oocytes and the E2 levels on the HCG day can be used as a auxiliary predictive factor for moderate and severe OHSS. In patients with high risk of OHSS , frozen embryo transfer after whole - embryo freezing can avoid the occurrence of OHSS.