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目的:探讨在IVF-ET过程中出现卵巢过渡刺激综合征(OHSS)倾向的患者实施选择性单胚胎移植的临床结局及对预防OHSS的作用。方法:将97例IVF-ET过程中出现OHSS风险的患者随机分为A组(n=59),进行择性单胚胎移植(eSET);B组(n=38),放弃本周期,实行全胚冷冻。比较A、B组患者中-重度OHSS的发生率及治疗情况,并计算eSET的临床指标。采用Logistic回归分析可能影响中-重度OHSS发生的原因;另外采用ROC曲线分析窦卵泡,取卵数与中-重度OHSS发生的关系。结果:A组(eSET)临床妊娠率为35.6%,胚胎种植率为35.6%,活产率为32.2%。A、B组中-重度OHSS住院率、平均住院天数、治疗情况、胸水发生率无统计学差异(P>0.05)。但在发生OHSS病例中,妊娠组平均住院天数增加、腹腔穿刺比例与非妊娠者比较明显增加(P<0.05);进入Logistic回归模型的危险因素为窦卵泡(OR=1.57,95%CI=1.18～2.09)及取卵数(OR=1.57,95%CI=1.02～1.47),P均<0.05,均为危险因素;窦卵泡与取卵数预测OHSS发生率的曲线下面积(AUC)分别为0.81(95%CI=0.68～0.93)和0.69(95%CI=0.57～0.82)。依据ROC曲线提示当窦卵泡数>15个和取卵数>22个时发生中-重度OHSS的可能性较大。结论:选择性单胚胎移植对于IVF过程中出现OHSS风险倾向的患者不失是一种选择,既保证了本周期一定的妊娠率,也没有明显增加中-重度OHSS的发生风险,但临床妊娠者可能病程较长、病情较严重。
OBJECTIVE: To investigate the clinical outcomes of selective single embryo transfer in patients with pro-ovarian transition syndrome (OHSS) predisposition in IVF-ET and its role in the prevention of OHSS. Methods: Ninety-seven patients with OHSS risk during IVF-ET were randomly divided into group A (n = 59) and selective single embryo transfer (eSET). Group B (n = 38) Embryo frozen. The incidence and treatment of moderate-severe OHSS in patients A and B were compared, and the clinical parameters of eSET were calculated. Logistic regression analysis was used to analyze the possible causes of moderate-severe OHSS. ROC curves were also used to analyze the relationship between antral follicles, number of oocytes retrieved and the incidence of moderate-severe OHSS. Results: The clinical pregnancy rate in group A (eSET) was 35.6%, the embryo implantation rate was 35.6% and the live birth rate was 32.2%. In group A and group B, there was no significant difference in the incidence of severe OHSS, average hospitalization days, treatment, and pleural effusion (P> 0.05). However, in the cases of OHSS, the average length of stay in pregnancy group increased, and the proportion of abdominal puncture increased significantly compared with non-pregnant women (P <0.05). The risk factors of Logistic regression model were antral follicles (OR = 1.57, 95% CI = 1.18 ~ 2.09), and the number of oocytes retrieved (OR = 1.57, 95% CI = 1.02-1.47, P <0.05, respectively) were risk factors. The area under the curve (AUC) 0.81 (95% CI = 0.68-0.93) and 0.69 (95% CI = 0.57-0.82). According to the ROC curve, it is highly likely that moderate to severe OHSS will occur when the number of antral follicles is> 15 and the number of oocytes is> 22. CONCLUSIONS: Selective single embryo transfer is an option for patients at risk of developing OHSS during IVF, which guarantees a certain pregnancy rate during the IVF and does not significantly increase the risk of moderate-severe OHSS, but clinical pregnancy May be longer duration, more serious condition.