新鲜胚胎与冷冻胚胎在多囊卵巢综合征不孕中的应用。

Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome.

机构信息

From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.).

出版信息

N Engl J Med. 2016 Aug 11;375(6):523-33. doi: 10.1056/NEJMoa1513873.

DOI:10.1056/NEJMoa1513873

PMID:27509101

Abstract

BACKGROUND

The transfer of fresh embryos is generally preferred over the transfer of frozen embryos for in vitro fertilization (IVF), but some evidence suggests that frozen-embryo transfer may improve the live-birth rate and lower the rates of the ovarian hyperstimulation syndrome and pregnancy complications in women with the polycystic ovary syndrome.

METHODS

In this multicenter trial, we randomly assigned 1508 infertile women with the polycystic ovary syndrome who were undergoing their first IVF cycle to undergo either fresh-embryo transfer or embryo cryopreservation followed by frozen-embryo transfer. After 3 days of embryo development, women underwent the transfer of up to two fresh or frozen embryos. The primary outcome was a live birth after the first embryo transfer.

RESULTS

Frozen-embryo transfer resulted in a higher frequency of live birth after the first transfer than did fresh-embryo transfer (49.3% vs. 42.0%), for a rate ratio of 1.17 (95% confidence interval [CI], 1.05 to 1.31; P=0.004). Women who underwent frozen-embryo transfer also had a lower frequency of pregnancy loss (22.0% vs. 32.7%), for a rate ratio of 0.67 (95% CI, 0.54 to 0.83; P<0.001), and of the ovarian hyperstimulation syndrome (1.3% vs. 7.1%), for a rate ratio of 0.19 (95% CI, 0.10 to 0.37; P<0.001), but a higher frequency of preeclampsia (4.4% vs. 1.4%), for a rate ratio of 3.12 (95% CI, 1.26 to 7.73; P=0.009). There were no significant between-group differences in rates of other pregnancy and neonatal complications. There were five neonatal deaths in the frozen-embryo group and none in the fresh-embryo group (P=0.06).

CONCLUSIONS

Among infertile women with the polycystic ovary syndrome, frozen-embryo transfer was associated with a higher rate of live birth, a lower risk of the ovarian hyperstimulation syndrome, and a higher risk of preeclampsia after the first transfer than was fresh-embryo transfer. (Funded by the National Basic Research Program of China and others; ClinicalTrials.gov number, NCT01841528.).

摘要

背景

体外受精（IVF）一般更倾向于移植新鲜胚胎，而不是冷冻胚胎，但一些证据表明，冷冻胚胎移植可能会提高多囊卵巢综合征患者的活产率，降低卵巢过度刺激综合征和妊娠并发症的发生率。

方法

本多中心试验纳入了 1508 名正在进行首次 IVF 周期的多囊卵巢综合征不孕妇女，将其随机分为新鲜胚胎移植组或胚胎冷冻保存后行冷冻胚胎移植组。胚胎培养 3 天后，最多移植 2 枚新鲜或冷冻胚胎。主要结局为首次胚胎移植后的活产。

结果

与新鲜胚胎移植组（42.0%）相比，冷冻胚胎移植组首次移植后的活产率更高（49.3%），活产率比值为 1.17（95%置信区间[CI]，1.05 至 1.31；P=0.004）。行冷冻胚胎移植的妇女流产率也较低（22.0% vs. 32.7%），流产率比值为 0.67（95%CI，0.54 至 0.83；P<0.001），卵巢过度刺激综合征发生率较低（1.3% vs. 7.1%），比值为 0.19（95%CI，0.10 至 0.37；P<0.001），但子痫前期发生率较高（4.4% vs. 1.4%），比值为 3.12（95%CI，1.26 至 7.73；P=0.009）。两组间其他妊娠和新生儿并发症发生率无显著差异。冷冻胚胎组有 5 例新生儿死亡，新鲜胚胎组无新生儿死亡（P=0.06）。