全部胚胎冷冻患者取卵后卵巢恢复情况及妊娠结局的相关因素分析

Study of ovarian recovery time after oocyte retrieval and the relationship between pregnancy outcomes and embryo transfer time in patients who undergo freeze-all strategy

目的探究在行体外受精助孕技术中行全部胚胎冷冻的患者取卵后卵巢恢复时间及不同时间间隔后行冻融胚胎移植的妊娠结局。方法采用前瞻性队列研究,随访了2017年7月至12月期间于山东大学附属生殖医院行辅助生殖助孕技术助孕、行全部胚胎冷冻的53例患者,比较取卵后第1次月经周期第2~4日血雌二醇的水平,对比患者取卵后第2次月经周期的排卵情况;并比较所有行冻融胚胎移植的患者妊娠结局的不同。结果88.68%(47/53)的患者在取卵后第1次月经第2~4日血雌二醇水平降至50 ng/L以下,且与患者年龄(≤30岁、>30岁)(P=0.161)、促排卵方案(长方案、短方案、拮抗剂方案)(P=0.516)、是否多囊卵巢综合征(P=0.661)、获卵数(≤15枚、>15枚)(P=0.671)无关。非多囊卵巢综合征且既往月经规律的患者中,76.00%(19/25)的患者在取卵后第2个月经周期已恢复排卵,中位排卵时间为月经第16日。取卵后第2次月经后移植与取卵后第3次月经及以后移植的患者妊娠结局差异无统计学意义,其中多囊卵巢综合征患者与非多囊卵巢综合征患者的妊娠结局差异无统计学意义(P>0.05)。结论在行体外受精助孕技术中取卵后行全部胚胎冷冻的患者,如无禁忌,可尽早移植冻融胚胎。

Objective To explore the recovery time of ovary in patients who underwent all embryo freezing after oocyte retrieval in in vitro fertilization(IVF)and the relationship between pregnancy outcome and embryo transfer time.Methods This research included 53 patients who underwent all embryos freezing in the Reproductive Hospital of Shandong University from July to December in 2017.The baseline level of serum estradiol in the first menstrual cycle after oocyte retrieval and the ovulation time during the second menstrual cycle after oocyte retrieval was assessed in 53 patients.In addition,the pregnancy outcomes of all patients underwent frozen-thawed embryo transfer were followed up.Results During the second to the fourth day of the first menstrual cycle after oocyte retrieval,88.68%(47/53)of the patients had a blood estradiol level below 50 ng/L,which had no relationship with the age of the patients(≤30 years old,>30 years old)(P=0.161),the method of ovulation induction(P=0.516),with or without polycystic ovary syndrome(P=0.661),the number of oocyte obtained(≤15,>15)(P=0.671).Among patients without polycystic ovary syndrome and regular menstrual cycle,76.00%(19/25)of patients had recovered ovulation in the second menstrual cycle after oocyte retrieval,and the median ovulation time was the 16th day of menstruation cycle.There was no significant difference in the pregnancy outcomes between patients who had embryo transfer during the second menstrual cycle and patients who had embryo transfer during the third menstrual cycle or later(P>0.05).Conclusion It is rational to transfer embryo earlier for patients who underwent all embryo freezing after oocyte retrieval in IVF.