卵巢过度刺激高风险患者全胚冷冻后择期移植妊娠结局分析

目的于体外受精(IVF)超排卵周期取卵后及移植前,对根据血液指标和超声指标诊断为卵巢过度刺激综合征(OHSS)高风险患者,在充分知情同意下由患者自行选择新鲜胚胎移植或全胚冷冻后择期冻胚移植,观察比较两种情况下妊娠结局。方法回顾性分析我中心2012年1月1日至2013年6月30日期间进行IVF且有OHSS高风险的患者共374例,分为鲜胚胎移植组(A组)65例和全胚冷冻后择期冻胚移植组(B组)309例,比较两组妊娠结局的相关指标。结果 A组的妊娠率、种植率、流产率、异位妊娠率分别为41.5%(27/65)、30.0%(39/130)、7.4%(2/27)、3.7%(1/27),B组分别为69.6%(215/309)、50.2%(310/618)、7.0%(15/215)、3.7%(8/215),两组间妊娠率和种植率均有显著性差异(P0.05),而流产率、异位妊娠率则无显著性差异(P0.05)。OHSS发生率A组为10.8%,而B组仅为1.6%,两组间差异有统计学意义。结论对于有OHSS高风险的患者应该果断选择全胚冷冻并择期行冻胚移植,可减少甚至杜绝OHSS的发生,从而提高IVF安全性并可获得更为满意的妊娠结局,且可降低患者的治疗费用。

Comparison of pregnancy outcome between fresh embryo transfer and frozen embryo transfer in IVF/ICSI for patients with high risk of ovarian hyperstimulation syndrome

Objective. To compare the pregnancy outcome between fresh embryo transfer ： and frozen embryo transfer in IVF/ICSI for patients with high risk of ovarian hyperstimulation syndrome（OHSS）. Methods： The data of 374 patients with high risk of OHSS in IVF/ICSI treatment cycle in our reproductive center from January 1,2012 to June 30,2013 were retrospectively analyzed. The patients were divided into two groups：group A with 65 fresh embryo transfer cycles and group B with 309 frozen embryo transfer cycles. The indexes of pregnancy outcome were compared between the two groups. Results： The implantation rate（30.0% vs. 50. 2%）and clinical pregnancy rate（41.5% vs. 69.6%）in group B were significantly higher than those in group A （P〈0.05）, but no significant differences were found in abortion rate and ectopic pregnancy rate. And the incidence of OHSS in group A was significantly higher than that in group B（P〈0.05）. Conclusians. In patients with high risk of OHSS, frozen embryo transfer after whole embryo cryOpreservation could effectively avoid the occurrence of OHSS and get better clinical pregnancy rate comparing with fresh embryos transfer.