COGI Congress, Department of OB/GYN, Laniado Medical Center, Netanya, Israel, affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Hum Reprod. 2020 Oct 1;35(10):2179-2184. doi: 10.1093/humrep/deaa204.
Elective 'freeze all', also called 'freeze only', refers to an IVF cycle where all embryos are frozen for later embryo transfer in a non-stimulated cycle, with the promise of increased success rates and prevention of ovarian hyperstimulation syndrome (OHSS) in most patients. However, 'freeze all' is associated with significantly higher perinatal complications including eclampsia, preeclampsia, chronic hypertension and large-for-gestational-age infants, without the demonstrated advantages of providing better results, except for a decrease in the incidence of OHSS, which should matter to women with polycystic ovary syndrome (PCOS) and high responders to ovarian stimulation but not to all patients. 'Freeze all' is also suggested for all simulated IVF cycles, due to the alleged 'faulty endometrium' caused by ovarian stimulation. However, there is no direct evidence that asynchronous endometrium exists, and only if preovulatory progesterone level increase, can 'freeze all' confer an advantage. We conclude that an alleged diagnosis of 'faulty endometrium' should not be used as an indication for 'freeze all'. To offset the risk of OHSS more simply, less costly and less risky solutions such as mild ovarian stimulation, to dampen the number of oocytes and to aim for transfer of a single blastocyst, should be the preferred solution to treat women with PCOS and high responders for oocyte retrieval.
“选择性全冷冻”，也称为“仅冷冻”，是指在 IVF 周期中冷冻所有胚胎，以备在非刺激周期中进行胚胎移植，以期提高成功率并预防大多数患者的卵巢过度刺激综合征（OHSS）。然而，“全冷冻”与围产期并发症显著增加有关，包括子痫前期、子痫、慢性高血压和大于胎龄儿，除了降低 OHSS 的发生率外，没有显示出提供更好结果的优势，对于多囊卵巢综合征（PCOS）和卵巢刺激反应高的女性很重要，但对所有患者并非如此。由于卵巢刺激引起的所谓“子宫内膜功能不全”，“全冷冻”也被建议用于所有模拟 IVF 周期。然而，没有直接证据表明存在异步子宫内膜，只有在排卵前孕激素水平升高时，“全冷冻”才能带来优势。我们得出结论，所谓的“子宫内膜功能不全”诊断不应该作为“全冷冻”的指征。为了更简单、更经济、更安全地降低 OHSS 的风险，可以采用轻度卵巢刺激等解决方案，减少卵子数量，并将单个囊胚进行移植，这应该是治疗 PCOS 患者和卵巢刺激反应高的患者取卵的首选方案。
