全胚冷冻后首次冻融胚胎移植与新鲜胚胎移植的临床结局分析

目的:探讨全胚冷冻后首次冻融胚胎移植(FET)与新鲜胚胎移植周期的临床结局及应用价值。方法:回顾性分析2011年1月~2013年12月在本中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)患者的临床资料,比较刺激周期行新鲜胚胎移植(鲜胚移植组,324例)和全部胚胎冷冻后再行FET(FET组,179例)的临床妊娠率、种植率、活产率、异位妊娠发生率、流产率以及卵巢过度刺激综合征(OHSS)发生率。结果:两组患者的年龄、不孕年限、基础(月经第3天)卵泡刺激素(FSH)水平、促性腺激素(Gn)用药起始量、促排卵时间、受精率、2PN率、卵裂率、优质胚胎率及移植胚胎数均无统计学差异(P0.05);FET组Gn用药总量低于鲜胚移植组(P0.05),hCG注射日雌二醇(E2)水平、孕酮(P)水平、卵泡数和获卵数均较鲜胚移植组显著升高(P0.05);FET组的胚胎种植率(37.23%)和临床妊娠率(59.22%)均高于鲜胚移植组(29.56%,49.07%),差异有统计学意义(P0.05);两组的活产率、多胎妊娠率、异位妊娠率和流产率差异无统计学意义(P0.05);FET组具有较低的OHSS发生率(0.56%,P0.05)。结论:对于OHSS高危患者,全胚冷冻后行FET可提高临床妊娠率和胚胎种植率,且能有效避免OHSS发生,获得较满意的临床结局。

Clinical outcome of subsequent frozen-thawed embryo transfer and fresh embryo transfer

Objective： To compare the clinical outcome and application of subsequent frozen-thawed embryo transfer （FET） cycle and fresh embryo transfer （ET） cycle. Methods： The clinical pregnancy rate, implantation rate, live birth rate, ectopic pregnancy rate, miscarriage rate and ovarian hyper-stimulation syndrome （OHSS） rate were retrospec- tively analyzed between fresh ET（fresh ET group, n= 324） and subsequent FET（FET group, n= 179） after in vitro fertilization （IVF）/intracytoplasmic sperm injection （ICSI）-ET from January 2011 to December 2013 in Center for Re- productive Medicine, Renmin Hospital of Wuhan University. Results： There were no significant differences in age, in- fertility duration, basal follicle-stimulating hormone （FSH）, initial gonadotropin （Gn） dosage, days of stimulation, fertilization rate, 2PN rate, cleavage rate, good-quality embryo rate and numbers of embryo transferred between two groups （P all ~0.05）. The total Gn dosage in FET group was significantly lower than that in fresh ET group （P~ 0.05）, but the levels of estradiol （E2） and progesterone （P） on human chorionic gonadotrophin （hCG） day, the num- ber of follicle on hCG day and the number of oocyte retrieved were significantly higher than those in fresh ET group re- spectively （P~0.05）. The clinical pregnancy rate （37.23%） and implantation rate （59.22%） in FET group were sig- nificantly higher than those in fresh ET group （29.56% vs. 49.07%, P〈0.05）, while there were no significant differ- ences in live birth rate, multiple pregnancy rate and ectopic pregnancy rate between two groups （P all 〉0.05）, and FET group has relatively lower ovarian hyper-stimulation syndrome （OHSS） rate （0.56%） compared with fresh ET group. Conclusion： For patients at high risk of OHSS, freezing whole embryos and subsequent FET can significantly improve the clinical pregnancy rate and implantation rate, and it can also effectively prevent OHSS, and get satisfacto ry clinic