解冻或新鲜周期胚胎移植对PCOS患者妊娠结局的影响

The influence of thawing embryo transfer cycle and fresh embryo transfer cycle on the pregnancy outcomes of patients with polycystic ovary syndrome

目的:探讨解冻周期或新鲜周期胚胎移植对多囊卵巢综合征(PCOS)患者妊娠结局的影响。方法:回顾性收集2016年1月—2020年1月在本院生殖医学中心接受辅助生殖技术助孕的PCOS患者651例临床资料,其中新鲜周期胚胎移植255例(新鲜组),解冻周期胚胎移植396例(解冻组)。对两组临床资料及随访数据进行回顾性分析,比较两组妊娠结局。结果:解冻组hCG日促性腺激素(Gn)总用量均低于新鲜组,人绒毛膜促性腺激素(hCG)日孕激素、hCG日卵泡数、获卵数均高于新鲜组(P<0.05)。两组hCG日雌激素、异位妊娠、自然流产、多胎妊娠、围生期死亡、出生缺陷发生率等均无差异(P>0.05);解冻组胚胎种植率(54.0%)、临床妊娠率(76.8%)均高于新鲜组(43.9%、58.8%),早产(7.8%)、卵巢过度刺激综合征(OHSS)(2.0%)发生率低于新鲜组(14.9%、9.0%)(P<0.05)。新鲜组共出生319例胎儿,解冻组共出生492例胎儿。解冻组新生儿的出生体重高于新鲜组,低体重儿比率低于新鲜组(P<0.05),巨大儿比率两组无差异(P>0.05)。结论:相比新鲜周期胚胎移植,解冻周期胚胎移植PCOS患者的临床妊娠率及活产率更高,还能降低OHSS发生,从而改善妊娠结局。

Objective:To investigate the effect of thawing embryo transfer cycle and fresh embryo transfer cycle on the pregnancy outcomes of patients with polycystic ovary syndrome(PCOS).Methods:The clinical data of 651 patients with PCOS who had received assisted reproductive technology from January 2016 to January 2020 were collected retrospectively,which included 255 patients with fresh embryo transfer in group A,and 396 patients with thawing embryo transfer in group B.The followed up data of the patients in the two groups were analyzed,and the pregnancy outcomes of the patients were compared between the two groups.Results:The total dose of gonadotropin(Gn)on hCG day of the patients in group B was significant lower than that of the patients in group A,but the progesterone level,the numbers of follicles and eggs obtained of the patients in group B were significant higher than those of the patients in group A(P<0.05).There were no significant differences in the estrogen level on hCG day,and the incidences of ectopic pregnancy,spontaneous abortion,multiple pregnancy,perinatal fetal death,and birth defects of the patients between the two groups(P>0.05).The embryo implantation rate(54.0%)and clinical pregnancy rate(76.8%)of the patients in group B were significant higher than those(43.9%and 58.8%)of the patients in group A,but the incidences of premature birth(7.8%)and ovarian hyperstimulation syndrome(OHSS,2.0%)of the patients in group B were significant lower than those(14.9%and 9.0%)of the patients in group A(P<0.05).There were 319 births in group A and 492 births in group B.The birth weight of neonates in group B was significant higher than that of neonates in group A,and the ratio of low birth weight infants in group B was significant lower than that in group A(P<0.05),but there was no significant difference in the rate of macrosomia between the two groups(P<0.05).Conclusion:Compared with those of fresh embryo transfer,the clinical pregnancy rate and live birth rate of thawing embryo transfer of patients with PCOS are higher with lower OHSS occurrence,so as to improve the pregnancy outcomes.