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Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome

Zi-Jiang Chen ... 其他 • 2016.08.11
• 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



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。






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)。



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)。


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.



1. Kissin DM, Jamieson DJ, Barfield WD. Monitoring health outcomes of assisted reproductive technology. N Engl J Med 2014;371:91-93

2. Kawwass JF, Kissin DM, Kulkarni AD, et al. Safety of assisted reproductive technology in the United States, 2000-2011. JAMA 2015;313:88-90

3. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update 2002;8:559-577

4. Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med 2002;346:725-730

5. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004;328:261-261

6. Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004;103:551-563

7. Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update 2012;18:485-503

8. Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome: a randomized, placebo-controlled, double-blind multicentre study. Hum Reprod 2006;21:80-89

9. Devroey P, Bourgain C, Macklon NS, Fauser BC. Reproductive biology and IVF: ovarian stimulation and endometrial receptivity. Trends Endocrinol Metab 2004;15:84-90

10. Bourgain CDP, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update 2003;9:515-522

11. Horcajadas JA, Riesewijk A, Polman J, et al. Effect of controlled ovarian hyperstimulation in IVF on endometrial gene expression profiles. Mol Hum Reprod 2005;11:195-205

12. Choux C, Carmignac V, Bruno C, Sagot P, Vaiman D, Fauque P. The placenta: phenotypic and epigenetic modifications induced by assisted reproductive technologies throughout pregnancy. Clin Epigenetics 2015;7:87-87

13. Kansal Kalra S, Ratcliffe SJ, Milman L, Gracia CR, Coutifaris C, Barnhart KT. Perinatal morbidity after in vitro fertilization is lower with frozen embryo transfer. Fertil Steril 2011;95:548-553

14. Maheshwari A, Pandey S, Shetty A, Hamilton M, Bhattacharya S. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertil Steril 2012;98:368-377

15. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders. Fertil Steril 2011;96:344-348

16. Shi Y, Wei D, Liang X, et al. Live birth after fresh embryo transfer vs elective embryo cryopreservation/frozen embryo transfer in women with polycystic ovary syndrome undergoing IVF (FreFro-PCOS): study protocol for a multicenter, prospective, randomized controlled clinical trial. Trials 2014;15:154-154

17. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25

18. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014;371:119-129

19. Chen ZJ, Zhang YW, Liu JY, et al. China diagnosis criteria of polycystic ovarian syndrome diagnosis Zhonghua Fu Chan Ke Za Zhi 2012;47:74-75

20. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981;140:815-830

21. Legro RS, Barnhart HX, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007;356:551-566

22. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003;9:505-514

23. Practice Committee of American Society for Reproductive Medicine; Practice Committee of Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril 2013;99:44-46

24. Puissant F, Van Rysselberge M, Barlow P, Deweze J, Leroy F. Embryo scoring as a prognostic tool in IVF treatment. Hum Reprod 1987;2:705-708

25. Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 1989;44:430-440

26. Harbin Consensus Conference Workshop Group. Improving the reporting of clinical trials of infertility treatments (IMPRINT): modifying the CONSORT statement. Hum Reprod 2014;29:2075-2082

27. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfers in high responders. Fertil Steril 2011;96:516-518

28. Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Obstetric outcome in singletons after in vitro fertilization with cryopreserved/thawed embryos. Hum Reprod 2012;27:1343-1350

29. Opdahl S, Henningsen AA, Tiitinen A, et al. Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group. Hum Reprod 2015;30:1724-1731

30. Ishihara O, Araki R, Kuwahara A, Itakura A, Saito H, Adamson GD. Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome: an analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan. Fertil Steril 2014;101:128-133

31. Davies MJ, Moore VM, Willson KJ, et al. Reproductive technologies and the risk of birth defects. N Engl J Med 2012;366:1803-1813

32. Wennerholm UB, Henningsen AK, Romundstad LB, et al. Perinatal outcomes of children born after frozen-thawed embryo transfer: a Nordic cohort study from the CoNARTaS group. Hum Reprod 2013;28:2545-2553

33. Pinborg A, Loft A, Aaris Henningsen AK, Rasmussen S, Andersen AN. Infant outcome of 957 singletons born after frozen embryo replacement: the Danish National Cohort Study 1995-2006. Fertil Steril 2010;94:1320-1327

34. Wennerholm UB, Söderström-Anttila V, Bergh C, et al. Children born after cryopreservation of embryos or oocytes: a systematic review of outcome data. Hum Reprod 2009;24:2158-2172

35. Haning RV Jr, Austin CW, Carlson IH, Kuzma DL, Shapiro SS, Zweibel WJ. Plasma estradiol is superior to ultrasound and urinary estriol glucuronide as a predictor of ovarian hyperstimulation during induction of ovulation with menotropins. Fertil Steril 1983;40:31-36

36. Wang JX, Norman RJ, Wilcox AJ. Incidence of spontaneous abortion among pregnancies produced by assisted reproductive technology. Hum Reprod 2004;19:272-277

37. Abdalla HI, Bhattacharya S, Khalaf Y. Is meaningful reporting of national IVF outcome data possible? Hum Reprod 2010;25:9-13

38. Maheshwari A, Bhattacharya S. Elective frozen replacement cycles for all: ready for prime time? Hum Reprod 2013;28:6-9

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