中-重度卵巢过度刺激综合征对IVF-ET单/双胎妊娠患者晚期结局的影响

Influence of moderate-severe ovarian hyperstimulation syndrome on terminal singleton and twin pregnancy outcome of in vitro fertilization and embryo transfer

摘要:

目的： 探讨中-重度卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）是否影响体外受精-胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）单/双胎妊娠晚期结局。方法： 选择2008年1月至2015年12月在焦作市妇幼保健院生殖医学中心行IVF-ET的助孕患者，对其中发生中-重度OHSS并妊娠至中晚期的115例患者一般临床资料及妊娠结局进行回顾性分析，根据患者年龄、不孕原因及所获成熟卵子数目配对选择同期行IVF助孕、新鲜周期移植未发生OHSS的145例患者为对照组。按分娩新生儿的数目将患者分为单胎妊娠组和双胎妊娠组，分别比较2组间患者的年龄、不孕年限、体质指数（body mass index，BMI）、基础卵泡刺激素（basal follicle stimulating hormone，bFSH）、促性腺激素（gonadotropin，Gn）总量、人绒毛促性腺激素（human chorionic gonadotropin，HCG）日血清E2（estradion，E2）、获卵数、2PN数、优质胚胎数、移植日子宫内膜厚度、移植胚胎数、患者分娩的孕周、新生儿出生体质量、早产率、剖宫产率、小于胎龄儿（small for gestation age infant，SGA）及妊娠并发症（包括妊娠期糖尿病、妊娠期高血压疾病、产后出血、前置胎盘、胎盘植入）。结果： 单胎组，OHSS组HCG日E2水平、SGA率均高于非OHSS组，差异具有统计学意义（P=0.00，P=0.00）；OHSS组BMI低于非OHSS组，差异具有统计学意义（P=0.00）。双胎组，2组患者一般资料及妊娠结局均无明显差异。结论： 中-重度OHSS可增加单胎妊娠患SGA风险；中-重度OHSS对双胎妊娠晚期结局无明显影响。

Abstract:

Objective: To investigate the influence of moderate-severe ovarian hyperstimulation syndrome (OHSS) on terminal singleton and twin pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET). Methods: A total of 260 patients underwent IVF-ET in our department from January 2008 to December 2015 were selected and clinical data and pregnancy outcome of 115 patients with moderate-severe OHSS were retrospectively analyzed. A total of 156 patients underwent IVF-ET according to age, cause of infertility and the number of mature oocytes, and did not develop OHSS within the fresh transplantation cycle were selected as the control group. According to the newborn amount, patients were divided into the singleton group and twin group, indicators including age, infertility duration, body mass index (BMI), basic of follicle-stimulation hornone (bFSH), total Gn amount, serum estradion (E2) on the day of human chorionic gonadotropin (HCG), the number of retrieved oocytes, 2PN number, high quality embryos, endometriai thickness on the day of embryo transfer, transferable embryos, gestational age of delivery, birth weight, preterm birth rate, cesarean section rate, small for gestation age infant (SGA), and morbidity of pregnancy complications (including, gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, placenta previa and placenta increta rate) between two groups were compared. Results: E2 level on the day of HCG and SGA rate in the singleton groupwere higher than that in the non OHSS group, with statistically significant difference (P=0.00, P=0.00). BMI in the OHSS group was lower than that in the non-OHSS group, with statistically significant difference (P=0.00). General data and pregnancy outcome in two groups had no significant differences. Conclusion: Moderate-severe OHSS can increase the risk of SGA in singleton pregnancy; moderate-severe OHSS has no obvious influence on terminal pregnancy outcome of twin pregnancy.