卵巢高反应患者全胚冷冻临床应用研究

目的 探讨卵巢高反应患者新鲜移植周期与冻融胚胎移植(frozen-thawed embryo transfer, FET)周期妊娠结局的差异，了解促排卵药物对新鲜周期子宫内膜容受性的影响。方法 回顾性分析2011年1月至2013年12月在中国医科大学附属盛京医院生殖中心促排卵周期行新鲜胚胎移植(582例)和全部胚胎冷冻再行FET(167例)周期的临床妊娠率、生化妊娠率、种植率、胚胎停育率、异位妊娠率、流产率、持续妊娠率和多胎妊娠率。结果 582例促排卵周期新鲜胚胎移植与167例FET周期比较临床妊娠率（42.44% vs. 69.46%），生化妊娠率（7.22% vs. 2.99%），种植率（28.27% vs. 48.99%），胚胎停育率（8.10% vs. 7.76%），异位妊娠率（5.26% vs. 4.31%），流产率（8.10% vs. 6.90%），持续妊娠率（34.19% vs. 59.88%），多胎率（35.22% vs. 37.93%）。组间比较临床妊娠率、生化妊娠率、种植率、持续妊娠率差异均有统计学意义(P<0.05)。结论 全胚冷冻再行冻融周期移植可显著提高卵巢高反应患者临床妊娠率、种植率及持续妊娠率，不增加多胎率的发生，可获得更为理想的妊娠结局。新鲜周期高雌激素可能对子宫内膜容受性有损害作用。

The freeze-all embryo strategy applied to ovarian high responders.

Abstract： Objective To compare implantation and pregnancy outcome between fresh embryo transfer (ET) cycles after ovarian stimulation and frozen–thawed embryo transfer (FET) cycles in high responders and to evaluate the effect of fresh ET on endometrial receptivity.Methods We retrospectively analyzed 582 patients with fresh ET (fresh group) and 167 patients with FET (cryopreservation group) between January 2011 and December 2013 from Shengjing Hospital of China Medical University.The two groups were compared for clinical pregnancy rate, biochemical loss rate, implanting rates, embryonic diapaus rate, ectopic pregnancy rate, miscarriage rate, ongoing pregnancy rates and multiple pregnancy rates.Results The clinical pregnancy rate, biochemical loss rate , implantationy rates and ongoing pregnancy rates were 42.44% ,7.22%, 28.27% and 34.19% in fresh ET cycles, compared with 69.46%, 2.99%,48.99% and 59.88% in FET cycles. The clinical pregnancy rate , biochemical loss rate，implantation rates ,ongoing pregnancy rates were significantly different between fresh ET and FET cycles (P<0.05).Conclusions The clinical pregnancy rate, implantation rates and ongoing pregnancy rates are significantly greater in the fresh embryos which are cryopreserved and then transferred in FET cycles in high responders. These results strongly suggest freeze-allembryo strategy can obtain a more ideal pregnancy outcome. Impaired endometrial receptivity apparently accounts for most implantation failures in the fresh group.