全胚冷冻后冻融胚胎复苏移植与新鲜胚胎移植临床结局比较

Comparison of clinical outcomes between frozen-thawed embryo resuscitation transfer and fresh embryo transfer

目的比较行全胚冷冻后冻融胚胎复苏移植与新鲜胚胎移植妊娠结局的差异,探讨全胚冷冻的有效性和可行性。方法回顾性分析2014年6月至2015年6月在郑州大学第二附属医院生殖中心行辅助生殖助孕的819例患者的临床资料,根据胚胎移植方案将患者分为复苏周期组(n=214)和新鲜周期组(n=605)。复苏周期组患者根据全胚冷冻的原因分为卵巢过度刺激综合征(OHSS)组(n=153)、内膜过薄组(n=30)、宫腔异常组(n=18)和孕酮过高组(n=13)。比较5组患者的胚胎种植率、临床妊娠率及流产率。结果OHSS组、内膜过薄组、宫腔异常组、孕酮过高组和新鲜周期组患者年龄、人绒毛膜促性腺激素(HCG)日促黄体生成素值、移植胚胎数比较差异无统计学意义(P>0.05);OHSS组、内膜过薄组、宫腔异常组、孕酮过高组患者促性腺激素(Gn)使用时间、Gn总量、HCG日血清雌二醇(E2)值、HCG日孕酮值、HCG日子宫内膜厚度、获卵数均高于新鲜周期组(P<0.05)。OHSS组患者Gn使用时间、Gn总量、HCG日血清E 2值及获卵数高于内膜过薄组、宫腔异常组、孕酮过高组(P<0.05);内膜过薄组患者HCG日子宫内膜厚度低于宫腔异常组、孕酮过高组(P<0.05)。宫腔异常组患者HCG日孕酮值低于孕酮过高组(P<0.05)。OHSS组、内膜过薄组、宫腔异常组、孕酮过高组患者胚胎复苏率比较差异无统计学意义(P>0.05)。OHSS组、内膜过薄组、宫腔异常组、孕酮过高组胚胎种植率、临床妊娠率与新鲜周期组比较差异均有统计学意义(P<0.05),5组患者流产率比较差异无统计学意义(P>0.05)。OHSS组患者胚胎种植率和临床妊娠率高于宫腔异常组、孕酮过高组(P<0.05);OHSS组和内膜过薄组患者胚胎种植率和临床妊娠率比较差异无统计学意义(P>0.05);内膜过薄组患者胚胎种植率和临床妊娠率高于宫腔异常组和孕酮过高组(P<0.05);宫腔异常组和孕酮过高组患者胚胎种植率和临床妊娠率比较差异无统计学意义(P>0.05)。结论对于OHSS患者和内膜过薄患者,选择全胚冷冻后冻融胚胎复苏移植可获得更好的妊娠结局。

Objective To compare the pregnancy outcome between frozen-thawed embryo resuscitation transfer and fresh embryo transfer after whole embryo freezing and explore the feasibility and effectiveness of the whole embryo freezing.Methods The clinical data of 819 patients who underwent assisted reproduction in the Reproductive Center of the Second Affiliated Hospital of Zhengzhou University from June 2014 to June 2015 were retrospectively analyzed.All patients were divided into the resuscitation cycle group(n=214)and fresh cycle group(n=605)according to the embryo transfer protocol.The patients in the resuscitation cycle group were divided into the ovarian hyperstimulation syndrome(OHSS)group,thin endometrial group,abnormal uterine cavity group and high progesterone group according to the reasons why patients underwent freezing of whole embryos.The embryo implanting rate,clinical pregnancy rate and miscarriage rate of patients were compared among the five groups.Results There was no significant differences in age,luteinizing hormone value of human chorionic gonadotophin(HCG)day and number of transferred embryos among the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group and the fresh cycle group(P>0.05).The time of gonadotropins(Gn)used,the total amount of Gn,the serum estradial(E 2)value of HCG day,the progesterone value of HCG day,the thickness of endometrium of HCG day and the number of eggs obtained of patients in the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group were higher than those in the fresh cycle group(P<0.05).The time of Gn used,the total amount of Gn,the serum E2 value of HCG day and the number of eggs obtained of patients in the OHSS group were higher than those in the thin endometrial group,the abnormal uterine cavity group and the high progesterone group(P<0.05).The thickness of endometrium of HCG day of patients in the thin endometrial group was less than that in the abnormal uterine cavity group and the high progesterone group(P<0.05).The progesterone value of HCG day of patients in the abnormal uterine cavity group was lower than that in the high progesterone group(P<0.05).There was no significant difference in the recovery rate of embryo of patients among the OHSS group,thin endometrial group,abnormal uterine cavity group and the high progesterone group(P>0.05).There were significant differences in embryo implantation rate and clinical pregnancy rate among the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group and the fresh cycle group(P<0.05).There was no significant difference in aborti on rate among the five groups(P>0.05).The embryo implantation rate and clinical pregnancy rate of patients in the OHSS group were higher than those in the abnormal uterine cavity group and the high progesterone group(P<0.05);there was no significant difference in the embryo implantation rate and clinical pregnancy rate of patients between the OHSS group and the thin endometrial group(P>0.05);the embryo implantation rate and clinical pregnancy rate of patients in the thin endo-metrial group were higher than those in the abnormal uterine cavity group and the high progesterone group(P<0.05);there was no significant difference in the embryo implantation rate and clinical pregnancy rate of patients between the abnormal uterine cavity group and high progesterone group(P>0.05).Conclusions For the patients with OHSS and thin endometrium,choosing the freezing and thawing embryo resuscitation transfer after freezing the whole embryo will have a better pregnancy outcome.