[1]王　婧,谭　丽,卢　娜,等.全胚冷冻后冻融胚胎复苏移植与新鲜胚胎移植临床结局比较[J].新乡医学院学报,2020,37(10):945-949.[doi:10.7683/xxyxyxb.2020.10.010]
　WANG Jing,TAN Li,LU Na,et al.Comparison of clinical outcomes between frozen-thawed embryo resuscitation transfer and fresh embryo transfer[J].Journal of Xinxiang Medical University,2020,37(10):945-949.[doi:10.7683/xxyxyxb.2020.10.010]
点击复制

全胚冷冻后冻融胚胎复苏移植与新鲜胚胎移植临床结局比较
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年10
页码:
945-949
栏目:
临床研究
出版日期:
2020-10-05

文章信息/Info

Title:
Comparison of clinical outcomes between frozen-thawed embryo resuscitation transfer and fresh embryo transfer
作者:
王　婧1; 谭　丽2;  卢　娜2; 李　立1; 王宇明1
(1.河南省人民医院科研与学科建设部，河南　郑州　450003；2.郑州大学第二附属医院生殖医学部,河南　郑州　450000)
Author(s):
WANG Jing1; TAN Li2; LU Na2; LI Li1; WANG Yuming1
(1.Department of Research and Disciplinary Development,Henan Provincial People′s Hospital,Zhengzhou 450003，Henan Province,China；2.Department of Reproductive Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000，Henan Province,China)
关键词:
全胚冷冻; 新鲜胚胎移植; 冻融胚胎移植; 妊娠结局
Keywords:
freeze all embryo; fresh embryo transfer; frozen-thawed embryo transfer; pregnancy outcome
分类号:
R711.6
DOI:
10.7683/xxyxyxb.2020.10.010
文献标志码:
A
摘要:
目的　比较行全胚冷冻后冻融胚胎复苏移植与新鲜胚胎移植妊娠结局的差异，探讨全胚冷冻的有效性和可行性。方法　回顾性分析2014年6月至2015年6月在郑州大学第二附属医院生殖中心行辅助生殖助孕的819例患者的临床资料，根据胚胎移植方案将患者分为复苏周期组（n=214）和新鲜周期组(n=605)。复苏周期组患者根据全胚冷冻的原因分为卵巢过度刺激综合征（OHSS）组（n=153）、内膜过薄组（n=30）、宫腔异常组（n=18）和孕酮过高组（n=13）。比较5组患者的胚胎种植率、临床妊娠率及流产率。 结果　OHSS组、内膜过薄组、宫腔异常组、孕酮过高组和新鲜周期组患者年龄、人绒毛膜促性腺激素（HCG）日促黄体生成素值、移植胚胎数比较差异无统计学意义（P>0.05)；OHSS组、内膜过薄组、宫腔异常组、孕酮过高组患者促性腺激素（Gn）使用时间、Gn总量、HCG日血清雌二醇（E2） 值、HCG日孕酮值、HCG日子宫内膜厚度、获卵数均高于新鲜周期组（P<0.05)。OHSS组患者Gn使用时间、Gn总量、HCG日血清E2值及获卵数高于内膜过薄组、宫腔异常组、孕酮过高组（P<0.05）；内膜过薄组患者HCG日子宫内膜厚度低于宫腔异常组、孕酮过高组（P<0.05）。宫腔异常组患者HCG日孕酮值低于孕酮过高组（P<0.05）。OHSS组、内膜过薄组、宫腔异常组、孕酮过高组患者胚胎复苏率比较差异无统计学意义（P>0.05）。OHSS组、内膜过薄组、宫腔异常组、孕酮过高组胚胎种植率、临床妊娠率与新鲜周期组比较差异均有统计学意义（P<0.05)，5组患者流产率比较差异无统计学意义（P>0.05）。OHSS组患者胚胎种植率和临床妊娠率高于宫腔异常组、孕酮过高组（P<0.05）；OHSS组和内膜过薄组患者胚胎种植率和临床妊娠率比较差异无统计学意义（P>0.05）；内膜过薄组患者胚胎种植率和临床妊娠率高于宫腔异常组和孕酮过高组（P<0.05）；宫腔异常组和孕酮过高组患者胚胎种植率和临床妊娠率比较差异无统计学意义（P>0.05）。结论　对于OHSS患者和内膜过薄患者，选择全胚冷冻后冻融胚胎复苏移植可获得更好的妊娠结局。
Abstract:
Objective　To compare the pregnancy outcome between frozen-thawed embryo resuscitation transfer and fresh embryo transfer after whole embryo freezing and explore the feasibility and effectiveness of the whole embryo freezing.Methods　The clinical data of 819 patients who underwent assisted reproduction in the Reproductive Center of the Second Affiliated Hospital of Zhengzhou University from June 2014 to June 2015 were retrospectively analyzed.All patients were divided into the resuscitation cycle group (n=214) and fresh cycle group (n=605) according to the embryo transfer protocol.The patients in the resuscitation cycle group were divided into the ovarian hyperstimulation syndrome(OHSS) group,thin endometrial group,abnormal uterine cavity group and high progesterone group according to the reasons why patients underwent freezing of whole embryos.The embryo implanting rate,clinical pregnancy rate and miscarriage rate of patients were compared among the five groups.Results　There was no significant differences in age,luteinizing hormone value of human chorionic gonadotophin（HCG） day and number of transferred embryos among the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group and the fresh cycle group(P>0.05).The time of gonadotropins(Gn) used,the total amount of Gn,the serum estradial(E2) value of HCG day,the progesterone value of HCG day,the thickness of endometrium of HCG day and the number of eggs obtained of patients in the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group were higher than those in the fresh cycle group(P<0.05).The time of Gn used,the total amount of Gn,the serum E2 value of HCG day and the number of eggs obtained of patients in the OHSS group were higher than those in the thin endometrial group,the abnormal uterine cavity group and the high progesterone group(P<0.05).The thickness of endometrium of HCG day of patients in the thin endometrial group was less than that in the abnormal uterine cavity group and the high progesterone group(P<0.05).The progesterone value of HCG day of patients in the abnormal uterine cavity group was lower than that in the high progesterone group(P<0.05).There was no significant difference in the recovery rate of embryo of patients among the OHSS group,thin endometrial group,abnormal uterine cavity group and the high progesterone group(P>0.05).There were significant differences in embryo implantation rate and clinical pregnancy rate among the OHSS group,thin endometrial group,abnormal uterine cavity group,high progesterone group and the fresh cycle group(P<0.05).There was no significant difference in abortion rate among the five groups (P>0.05).The embryo implantation rate and clinical pregnancy rate of patients in the OHSS group were higher than those in the abnormal uterine cavity group and the high progesterone group(P<0.05);there was no significant difference in the embryo implantation rate and clinical pregnancy rate of patients between the OHSS group and the thin endometrial group (P>0.05);the embryo implantation rate and clinical pregnancy rate of patients in the thin endo-metrial group were higher than those in the abnormal uterine cavity group and the high progesterone group(P<0.05);there was no significant difference in the embryo implantation rate and clinical pregnancy rate of patients between the abnormal uterine cavity group and high progesterone group(P>0.05).Conclusion　For the patients with OHSS and thin endometrium,choosing the freezing and thawing embryo resuscitation transfer after freezing the whole embryo will have a better pregnancy outcome.

参考文献/References:

［1］　SANTOS-RIBEIRO S,SIFFAIN J,POLYZOS N P,et al.To delay or not to delay a frozen embryo transfer after a failed freshembryo transnsfer attempt［J］.Fertil Steril,2016,105(5)：1202-1207.
［2］　LA MARCA A,SUNKARA S K.Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers:fromtheorytopractice［J］.Hum Reprod,2014，20(1):124-140.
［3］　MAHESHWARI A,BHATTACHARYA S.Elective frozen replacement cycles for all：ready for prime time［J］.Hum Reprod,2013,28（1）:6-9.
［4］　LAMBALK C B,BANGA F R,HUIRNE J A,et al.GnRH antagonist versus long agonist protocols in IVF:a systematic review and meta analysis accounting for patient type［J］.Hum Reprod,2017,23（5）：560-579.
［5］　谭巧，莫美兰，胡晓东，等.35周岁以下女性移植不同等级及不同发育速度冻融囊胚的临床结局［J］.生殖医学杂志，2017，26(8):759-765.
［6］　HEALY D L,BREHENY S,HALLIDAY J,et al.Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in victoria Australia［J］.Hum Reprod,2010,25(1)：265-274.
［7］　ROQUE M,LATTES K,SERRA S,et al.Fresh embryo transfer versus frozen embryo transfer in vitro fertilization cycles：a syste-matic review and meta-analysis［J］.Fertil Steril,2013,99(1)：156-162.
［8］　AFLATOONIAN A,OSKOUIAN H,AHMADI S,et al.Can fresh embryo transfers be replaced by cryopre-served-thawed embryo transfers in assisted reproductive cycles:a randomized controlled trial［J］.J Assisted Reprod Genet,2010,27(7)：357-363.
［9］　吕芳，于鲁华，王丽萍，等.全胚冷冻周期患者不同冻融胚胎移植次数的临床妊娠结局分析［J］.中华妇幼临床医学杂志，2017，13(5):569-573.
［10］　宋梦玲，徐仙，胡蓉，等．冻融胚胎移植妊娠结局影响因素的分析［J］.山东医药,2013,53(7):4-7.
［11］　STEWARD R G,LAN L,Shah A A,et al.Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth：an analysis of 256 381 in vitro fertilization cycles［J］.Fertil Steril,2014,101(4):967-73.
［12］　SALUMENTS A,TAYRI T,MAKINEN S,et al.Effect of development stage of embryo at freezing on pregnancy outcome of frozen-thawed embryo transfer［J］.Hum Reprod,2003,18(9):1890-1895.
［13］　叶虹，黄国宁，裴莉，等.控制性超排卵中血清孕酮浓度升高对体外受精-胚胎移植的影响［J］.实用妇产科杂志，2003，19(5):285-287.
［14］　KI K K,HYEIN K,OH S,et al.Development of a novel nomogram for predicting ongoing pregnancy after in vitro fertilization and embryo transfer［J］.Obstet Gynecol Sci,2018,61(6):669-674.

更新日期/Last Update: 2020-10-05