冻融囊胚移植在卵巢高反应患者中的应用价值

目的探讨冻融囊胚移植在卵巢高反应患者中的应用价值。方法回顾性分析2012年4月至2013年4月349例卵巢高反应患者的临床资料，按移植方案不同分为新鲜胚胎组（84例）、新鲜囊胚组（53例）、冻融胚胎组（102例）和冻融囊胚组（i10例）4组。比较4组患者的促排卵、胚胎质量、妊娠率、着床率和多胎率等。结果新鲜胚胎组、新鲜囊胚组、冻融胚胎组和冻融囊胚组患者移植优质胚胎率分别为73．37％（135／184）、71．70％（38／53）、70．50％（184／261）和68．27％（142／208），4组比较，差异均无统计学意义（P〉0．05）。4组患者的着床率分别为16．85％（31／184）、39．62％（21／53）、19．92％（52／261）和47．12％（98／208）；临床妊娠率分别为30．95％（26／84）、37．74％（20／53）、44．12％（45／102）和69．09％（76／110），4组比较，差异均有统计学意义（P〈0．05）。4组患者的流产率分别为15．38％（4／26）、15．00％（3／20）、11．11％（5／45）和11.84％（9／76），4组比较，差异无统计学意义（P〉0．05）。新鲜周期组移植后中重度卵巢过度刺激综合征（OHSS）发生率为（9．49％，13／137）。而冻融周期组移植无OHSS发生。两囊胚组异位妊娠率（1．04％，1／96）与两胚胎组（8．45％，6／71）比较，差异有统计学意义（P〈0．05）。结论卵巢高反应患者冻融囊胚移植在保证较高妊娠率的同时减少了OHSS及异位妊娠的发生。

Application of vitrified - thawed blastocyst transplant in high ovarian responders

Objective Discuss the application value of vitrified- thawed blastocyst transplant （VBT） in high ovarian responders. Methods The clinical data of 349 cases of high ovarian responders who received assisted reproductive technology during April 2012 to April 2013 were analyzed retrospectively. According to the different transplantation strategy, patients were divided into four groups： fresh embryo group （84 cases）, fresh blastocy group （53 cases）, vitrified- thawed embryo group （102 cases） and vitrified-thawed blastocyst group （110 cases）. Con- trolled ovarian hyperstimulation （COH）, pregnancy rate, implantation rate, multiple pregnancy rate and other complications were compared among the four groups. Results No significant differences were found in the four groups in embryo quality of transferred. Higher rates of pregnancy （69.09%, 76/110） and implantation （47.12%, 98/ 208） were found in the group of vitrified - thawed blastocyst group than that in other group （P〈0. 0083）. Among the four groups the abortion rate and multiple pregnancy rate had no significant difference. The occurrence of moder- ately severe OHSS rate was 9.49 % （13/137） in fresh group after transplantation, but there was no OHSS occurred in the vitrifiedthawed group. The blastocyst transplant group had lower ectopic pregnancy rate （1. 04%, 1/96） compared to the embryo transfer group （8.45%, 6/71） （P〈0.05）. Conchtsion Vitrified - thawed blastocyst transplant can ensure better pregnancy rate whereby reduce the incidence of ovarian hyperstimulation syndrome and ectopic pregnancy.