国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2019, Vol. 38 ›› Issue (3): 197-200.

• 论著 • 上一篇    下一篇

拮抗剂方案不同卵巢反应患者新鲜周期与冻融胚胎移植周期妊娠结局的比较

冯丽珍，刘岩，李娅，宋学茹，白晓红   

  1. 300052 天津医科大学总医院生殖医学中心
  • 收稿日期:2018-11-26 修回日期:2019-03-14 出版日期:2019-05-15 发布日期:2019-05-16

Pregnancy Outcomes of Fresh Cycle and FET Cycle in Patients with Different Ovarian Response on Antagonist Protocol

FENG Li-zhen，LIU Yan，LI Ya，SONG Xue-ru，BAI Xiao-hong   

  1. Reproductive Medical Center，Tianjin Medical University General Hospital，Tianjin 300052，China
  • Received:2018-11-26 Revised:2019-03-14 Published:2019-05-15 Online:2019-05-16

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摘要： 目的：比较促性腺激素释放激素（GnRH）拮抗剂方案下，不同卵巢反应患者新鲜周期与全胚冷冻后第一次冻融胚胎移植（frozen-thawed embryo transfer，FET）的妊娠结局。方法：回顾性分析2016年5月—2018年9月于天津医科大学总医院（我院）生殖中心行体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）治疗且使用GnRH拮抗剂方案的251个周期不孕症患者的数据。根据获卵数不同分为3组，A组33个周期（获卵数≤3个），B组157个周期（获卵数4～15个），C组47个周期（获卵数＞15个）。各组又进一步分为新鲜周期移植组（A1组18个周期、B1组99个周期、C1组15个周期）与全胚冷冻后第一次FET组（A2组15个周期、B2组58个周期、C2组46个周期）。比较各组患者促排卵情况和移植妊娠结局。结果：A1/A2组患者、B1/B2组患者、C1/C2组患者的年龄、体质量指数（BMI）、基础卵泡刺激素/黄体生成激素（bFSH/bLH）、不孕类型、Gn总量、使用Gn时间、受精方式及受精率比较，差异无统计学意义（均P＞0.05）。C2组患者获卵数比C1组多，差异有统计学意义（t=-2.963，P=0.000）。在结局指标中，B2组患者临床妊娠率比B1组高，差异有统计学意义（χ2=5.502，P=0.019）。C2组移植胚胎数和移植胚胎质量评分比C1组高，差异均有统计学意义（均P＜0.05），但胚胎种植率、临床妊娠率和流产率差异均无统计学意义（均P＞0.05）。结论：卵巢低反应患者建议优先选择新鲜周期移植；卵巢反应正常者建议优先考虑全胚冷冻后行FET；卵巢高反应患者为最大程度避免卵巢过度刺激的发生，建议全胚冷冻后行FET。

关键词: 受体, 促性腺激素, 排卵诱导, 生殖技术, 辅助, 新鲜胚胎移植, 冻融胚胎移植

Abstract: Objective：To compare the pregnancy outcomes bewteen the fresh embryo transfer (ET) and the first frozen thawed embryo transfer (FET) after embryo vitrification in patients with different ovarian response on the antagonist protocol. Methods：A total of 251 cycles of infertile patients undergoing IVF/ICSI-ET and the antagonist protocol of ovarian stimulation were retrospectively studied from May 2016 to September 2018 in our Reproductive Center. According to the ovarian response, those patients were divided into three groups, the group A including 33 cycles (the number of oocytes retrieved ≤3), the group B including 157 cycles (the number of oocytes retrieved 4 to 15) and the group C including 47 cycles (the number of oocytes retrieved ＞15). Further, each group was divided into the fresh embryo transfer sub-group (A1 of 18 cycles, B1 of 99 cycles, C1 of 15 cycles) and the first frozen thawed embryo transfer after embryo vitrification sub-group (A2 of 15 cycles, B2 of 58 cyles, C2 of 46 cycles). Basic parameters, the embryo implantation rate and the clinical pregnancy rate were compared. Results：There were no significant differences in age, body mass index (BMI), bFSH/bLH, sterility type, total Gn, days of Gn, insemination mode and insemination rate in A1/A2 group, B1/B2 group and C1/C2 group (all P＞0.05). The number of oocytes retrieved in the C2 sub-group was higher than that in C1 sub-group (t=-2.963, P=0.000). As for the outcomes, the clinical pregnancy rate in B2 sub-group was significantly higher than that in B1 sub-group ( χ2=5.502, P=0.019). The embryo number and embryo quality score in C2 sub-group were significantly higher than those in C1 sub-group (P＜0.05). However, there were no significant differences in the implantation rate, clinical pregnancy rate and abortion rate (all P＞0.05). Conclusions：Patients with low ovarian response should be recommended the fresh transplantation as priority selection. Patients with normal ovarian response should give priority to the whole-embryo freezing and then transfer the frozen-thawed embryo. In order to avoid the ovarian hyperstimulation to the greatest extent, patients with ovarian hyperresponsiveness should be directly recommended to give priority to the whole-embryo freezing and then transfer the frozen-thawed embryo.

Key words: Receptors, gonadotropin, Ovulation induction, Reproductive techniques, assisted, Fresh embryo transfer, Frozen thawed embryo transfer

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