南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (07): 929-.

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新鲜周期全胚冷冻策略不影响体外受精-胚胎移植妊娠及产科结局:≤35岁患者的疗效分析

孙玲,陈志恒,尹敏娜,邓宇   

  • 出版日期:2017-07-20 发布日期:2017-07-20

Pregnancy and obstetric outcomes of fresh embryo transfer versus frozen-thawed embryo transfer in women below 35 years of age

  • Online:2017-07-20 Published:2017-07-20

摘要: 目的比较新鲜周期行全胚冻存年轻患者和新鲜胚胎移植的临床妊娠结局及新生儿的产科结局,评价该策略的安全性及 临床应用价值。方法回顾性分析2011年1月~2015年12月在本中心进行体外受精-胚胎移植助孕治疗的卵巢功能正常的年龄 ≤35岁患者共2091个周期。促排卵治疗后全部胚胎冷冻,其后行第一周期冷冻复苏移植术的年轻患者796 例为研究组,同期 促排卵治疗后立即行新鲜周期移植的年轻患者1295 例为对照组。分析比较两组间临床妊娠结局及分娩结局。结果两组患者 平均不孕年限无统计学差异(P>0.05),平均年龄全胚冷冻组低于新鲜周期移植组(29.5岁vs 30.2岁)有统计学差异(P<0.05)。 两组患者促排卵天数和移植时子宫内膜厚度无统计学差异(P>0.05),全胚冷冻组促排卵总促性腺激素剂量较新鲜移植组低(P< 0.05),取卵前雌激素水平全胚组为12 973 pmol/L,明显高于新鲜移植组8673 pmol/L,平均获卵数全胚组是新鲜组的1.5倍,差 异均有显著性(P<0.05)。两组患者临床妊娠率及活产率均无统计学差异(P>0.05),全胚冷冻组无卵巢过度刺激综合征发生,而 新鲜移植组有20例发生中、重度卵巢过度刺激,差异有显著性(P=0.000)。两组患者的分娩孕周及新生儿平均体质量均无统计 学差异(P>0.05)。结论新鲜周期治疗中出现中、重度卵巢过度刺激综合征倾向取消新鲜周期移植而进行全胚冻存,择期行解 冻移植,可获得满意的临床妊娠结局及产科结局,是预防晚发性卵巢过度刺激综合征的一种理想方法。

Abstract: Objective To compare the obstetric and perinatal outcomes between fresh embryo transfer (ET) and frozen-thawed ET (the "freeze-all" strategy) and evaluate the benefits of the "freeze-all" embryo strategy for young patients. Methods We reviewed a total of 2091 ET cycles performed between January, 2011 and December, 2015 in women aged 20-35 years, including 1295 fresh ET cycles and 796 frozen-thawed ET cycles. The demographic characteristics, ovarian stimulation syndrome, clinical pregnancy rates, live birth rate and the obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups. Results The mean age of the patients receiving frozen-thawed ET cycles had a significantly younger age than those having fresh ET cycles (29.5 vs 30.2 years, P<0.05); the patients undergoing frozen-thawed ET cycles also had significantly higher estradiol level on the day of trigger (12 973 pmol/L vs 8673 pmol/L ) and a greater oocyte number retrieved (12.7 vs 8.7). The incidence of severe ovarian hyperstimulation syndrome was significantly lower in patients with frozen ET than those with fresh ET (P<0.05). No significant differences were found in the pregnancy rate (59.5% vs 56.0%; P> 0.05), live birth rate (50.3% vs 47.0%; P>0.05), mean birth weight or gestational age between the two groups. Conclusions The freeze-all policy produces similar pregnancy and obstetric outcomes with those of fresh ET. Our results support the hypothesis that the freeze-all strategy help to prevent OHSS with a good pregnancy rate.