卵巢过度刺激综合征患者胚胎发育及临床妊娠结局研究
Research on embryo development and clinical pregnancy outcomes in patients with ovarian hyperstimulation syndrome
王静 1程慧茹 1杨丹丹 1范咏琪 1陈蓓丽 1章志国 1曹云霞1
作者信息
- 1. 安徽医科大学第一附属医院妇产科 国家卫生健康委配子及生殖道异常研究重点实验室 生殖健康与遗传安徽省重点实验室,合肥 230032
- 折叠
摘要
目的 探讨辅助生殖技术中发生卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)患者的胚胎发育及临床妊娠结局.方法 对2019年8月至2021年8月期间在安徽医科大学第一附属医院妇产科行体外受精/卵胞质内单精子注射-胚胎移植治疗的4 080个周期的病例资料进行回顾性队列研究.按照是否发生OHSS分为OHSS组(n=524)与对照组(未发生OHSS患者,n=3 556);524个OHSS周期依据是否合并多囊卵巢综合征(polycystic ovary syndrome,PCOS)分为OHSS合并PCOS亚组(n=231)和OHSS合并非PCOS亚组(n=293).比较各组之间的基础资料、胚胎发育结局及临床结局.结果 ①OHSS组患者年龄[(30.7±3.6)岁]小于对照组[(31.5±4.8)岁,P<0.001]、获卵数[(28.2±5.7)枚]、优质胚胎率[52.7%(4 982/9 463)]、优质囊胚率[54.0%(5 059/9 371)]、生化妊娠率[75.0%(393/524)]、临床妊娠率[69.5%(364/524)]和活产率[58.0%(304/524)]显著高于对照组[(12.5±6.7)枚、49.8%(14 042/28 204)、51.4%(14 279/27 797)、59.5%(2 115/3 556)、54.1%(1 924/3 556)、43.6%(1 550/3 556),均P<0.001].②OHSS合并PCOS亚组患者年龄[(30.2±3.1)岁]低于OHSS合并非PCOS亚组[(31.1±4.0)岁,P=0.009];雌二醇[165.0(101.0,222.5)pmol/L]水平显著高于OHSS合并非PCOS亚组[141.0(81.0,202.0)pmol/L,P=0.005];优质胚胎率[56.3%(2 413/4 284)]、囊胚形成率[67.1%(2 846/4 239)]和优质囊胚率[57.7%(2 445/4 239)]均显著高于OHSS合并非PCOS亚组[49.6%(2 569/5 179)、60.3%(3 092/5 132)、50.9%(2 614/5 132),均P<0.001].结论 OHSS与年龄呈一定的相关性,其发生不会影响胚胎的发育,不增加不孕症患者的不良妊娠结局,是否合并PCOS不影响OHSS患者的妊娠结局,但在辅助生殖技术中我们仍要尽量避免OHSS等不良事件的发生.
Abstract
Objective To investigate the embryo development and clinical pregnancy outcomes in patients with ovarian hyperstimulation syndrome(OHSS)undergoing assisted reproductive technology(ART).Methods A retrospective cohort study was conducted on data from 4 080 cycles of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer treatments performed at the Department of Obstetrics and Gynecology,the First Affiliated Hospital of Anhui Medical University from August 2019 to August 2021.Patients were divided into OHSS group(n= 524)and non-OHSS group(control group,n=3 556)based on whether OHSS occurred,and the OHSS group was further divided into OHSS combined with polycystic ovary syndrome(PCOS)subgroup(n=231)and OHSS combined with non-PCOS subgroup(n=293)based on the presence of PCOS.General information,embryo developmental data and clinical outcomes were compared between the two groups.Results 1)Patients in the OHSS group[(30.7±3.6)years]were younger than those in control group[(31.5±4.8)years,P<0.001],and the number of retrieved oocytes(28.2±5.7),rates of high-quality embryos[52.7%(4 982/9 463)],blastocyst formation[54.0%(5 059/9 371)],biochemical pregnancy[75.0%(393/524)],clinical pregnancy[69.5%(364/524)],and live birth[58.0%(304/524)]were significantly higher in the OHSS group than in control group[12.5±6.7,49.8%(14 042/28 204),51.4%(14 279/27 797),59.5%(2 115/3 556),54.1%(1 924/3 556),43.6%(1 550/3 556),respectively;all P<0.001].2)Patients in the OHSS combined with PCOS subgroup[(30.2±3.1)years]were younger than those in the OHSS combined with non-PCOS subgroup[(31.1±4.0)years,P=0.009],and the estradiol level[165.0(101.0,222.5)pmol/L]was higher than that in the OHSS combined with non-PCOS subgroup[141.0(81.0,202.0)pmol/L,P=0.005];rates of high-quality embryos[56.3%(2 413/4 284)],blastocyst formation[67.1%(2 846/4 239)],and high-quality blastocysts[57.7%(2 445/4 239)]were also significantly higher in the OHSS combined with PCOS subgroup than in the OHSS combined with non-PCOS subgroup[49.6%(2 569/5 179),60.3%(3 092/5 132),50.9%(2 614/5 132),respectively;all P<0.001].Conclusion There is a certain correlation between OHSS and female age.The occurrence of OHSS does not affect embryo development and does not increase adverse pregnancy outcomes in infertile patients.The presence of PCOS does not affect the pregnancy outcomes of OHSS patients.However,in ART,we still strive to avoid the occurrence of adverse events such as OHSS as much as possible.
关键词
卵巢过度刺激综合征/生殖技术,辅助/多囊卵巢综合征/胚胎发育/妊娠结局Key words
Ovarian hyperstimulation syndrome/Reproductive technology,assisted/Polycystic ovary syndrome/Embryo development/Pregnancy outcome引用本文复制引用
基金项目
安徽省高校自然科学基金(KJ2021A0264)
出版年
2024
NETL
NSTL
万方数据