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新鲜或冷冻胚胎用于治疗多囊卵巢综合征不孕症的比较
Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome


Zi-Jiang Chen ... 妇产科和儿科 • 2016.08.11
相关阅读
• 体外受精和癌症风险:微妙的联系 • 冷冻全部胚胎会成为体外受精的决胜武器吗 • 用于排卵女性的新鲜和冷冻胚胎移植的比较

摘要


背景

一般认为,在体外受精(in vitro fertilization,IVF)中新鲜胚胎移植优于冷冻胚胎移植。但一些证据提示,冷冻胚胎移植可能提高活产率,并使患多囊卵巢综合征的妇女发生卵巢过度刺激综合征和妊娠并发症的比率降低。

 

方法

在这项多中心试验中,我们随机分配1,508例患多囊卵巢综合征并处于其首个IVF周期的不孕女性,进入新鲜胚胎移植组或胚胎冷冻保存后的冷冻胚胎移植组。在胚胎发育3天后,患者接受至多2个的新鲜或冷冻胚胎移植。主要结局是首次胚胎移植后的活胎出生。

 

结果

首次移植后,冷冻胚胎移植比新鲜胚胎移植导致的活产率更高(49.3%对42.0%),率比为1.17(95%可信区间[CI],1.05~1.31;P=0.004)。此外,接受冷冻胚胎移植的女性流产率较低(22.0%对32.7%),率比为0.67(95% CI,0.54~0.83;P<0.001),卵巢过度刺激综合征的发生率也较低(1.3%对7.1%),率比为0.19(95% CI,0.10~0.37;P<0.001);但这些女性先兆子痫的发生率较高(4.4%对1.4%),率比为3.12(95% CI,1.26~7.73;P=0.009)。在其他孕期和新生儿并发症的发生率在两组间无显著差异。冷冻胚胎组中有5名新生儿死亡,而新鲜胚胎组未发生(P=0.06)。

 

结论

在患多囊卵巢综合征的不孕女性中进行首次移植后,与新鲜胚胎移植相比,冷冻胚胎移植和更高的活产率、更低的卵巢过度刺激综合征风险及较高的先兆子痫风险相关(由中国国家重点基础研究计划[National Basic Research Program of China]等资助;在ClinicalTrials.gov注册号为NCT01841528)。





作者信息

Zi-Jiang Chen, M.D., Ph.D., Yuhua Shi, M.D., Ph.D., Yun Sun, M.D., Ph.D., Bo Zhang, M.D., Xiaoyan Liang, M.D., Ph.D., Yunxia Cao, M.D., Ph.D., Jing Yang, M.D., Ph.D., Jiayin Liu, M.D., Ph.D., Daimin Wei, M.D., Ph.D., Ning Weng, M.D., Lifeng Tian, M.D., Ph.D., Cuifang Hao, M.D., Ph.D., Dongzi Yang, M.D., Ph.D., Feng Zhou, M.S., Juanzi Shi, M.D., Ph.D., Yongle Xu, M.D., Jing Li, M.D., Junhao Yan, M.D., Ph.D., Yingying Qin, M.D., Ph.D., Han Zhao, M.D., Ph.D., Heping Zhang, Ph.D., and Richard S. Legro, M.D.
Address reprint requests to Dr. Chen at the Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, 324 Jingwu Rd., Jinan 250021, China, or at chenzijiang@hotmail.com.

 

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