Comparing The Pregnant Outcomes Of Different Transplantation Strategies In High Ovarian Response Patients In Assisted Reproductive Technology

Background and ObjectiveSince the birth of the world's first ?F in 1978 in the UK,assisted reproduction technology(ART)has been developed for more than 40 years.With the rapid development of society and the accelerated pace of life,people are facing increasing pressure.The incidence of infertility has increased year by year.In vitro fertilization-embryo transfer(?F-ET)and Other related assisted reproductive technologies are particularly important.Controlled ovarian stimulation(COS)is to induce the development and maturation of multiple follicles within a controlled range by means of drugs,and it is the key link of assisted reproduction technology.Due to individual differences in ovarian response to drugs,some patients may be abnormally sensitive,that is,the ovarian hyperresponsiveness is manifested by a large number of follicles that grow,develop,or mature,and produce a large amount of estradiol,which is likely to be complicated by ovarian hyperstimulation syndrome(OHSS).The European Human Reproduction and Embryology Association(ESHRE)believes that the real success of ART treatment is to obtain single full-term live births without the occurrence of OHSS.Therefore,how to improve the pregnancy rate and reduce the incidence of pregnancy complications for high-response populations has been a hot issue for clinicians.This article aims to compare the effects of fresh-cycle transplantation and the first frozen-thawed cycle transplantation after whole embryo freezing and different fresh-cycle transplantation strategies on pregnancy outcomes in ovarian high-response populations,hoping to provide individualized transplantation strategies and guide clinical work.Materials and Methods1 MaterialsRetrospective analysis of the clinical data of patients undergoing assisted reproduction and assisted pregnancy in our reproductive center from September 2017 to September 2019.Infertility factors are fallopian tube factors,ovulation disorders,and men with weak sperm.Inclusion criteria:(1)age?40 years;(2)number of eggs retrieved>15;(3)?F-ET/ICSI treatment;(4)short-acting GnRH-a long protocol or long-acting GnRH-a long protocol in follicular phase;(5)Transplanted embryos are high-quality embryos;(6)Clinical information is complete.Exclusion criteria:(1)genital tract and uterine malformations;(2)adenomyosis and endometriosis;(3)infertility of unknown cause;(4)combined with severe medical and surgical diseases;(5)chromosome nuclei Type exception.2 Experimental groupingAccording to whether the fresh cycle is transplanted,all patients are divided into the fresh cycle transplantation group and the first frozen-thawed cycle transplantation after whole embryo freezing(due to the high risk of OHSS);The fresh cycle transplantation group was further divided into single blastocyst transfer group(group A),double blastocyst transfer group(group B)and double cleavage stage embryo transfer group(group C)according to the embryo transfer situation.3 Statistical methodsSPSS22.0 software was used to process the data.Quantitative data was expressed as mean ±standard deviation((?)).If a normal distribution was followed,an independent sample t test was used for comparison between the two groups,and single-factor analysis of variance was used for comparison between multiple groups.The rank-sum test was used for disobeying normal distribution.Qualitative data was expressed as a rate(%),using chi-square test or Fisher's exact probability method,P<0.05 was considered statistically significant.Results1 Comparison between the fresh cycle transplantation group and the frozen-thawed cycle transplantation group in people with high ovarian response(1)Compared the fresh-cycle transplantation group with the frozen-thawed cycle group,there were no significant differences in age,infertility,BMI,bFSH,bE2,AFC,endometrial thickness,and number of embryos on the day of transplantation(P>0.05);The E2 on the trigger day in the frozen-thawed cycle group was higher than that in the fresh cycle transplantation group,and the difference was statistically significant(P<0.05).(2)The clinical pregnancy rate and embryo implantation rate in the frozen-thawed cycle group were higher than those in the fresh cycle transplantation group,and the differences were statistically significant(P<0.05);The incidence of moderate to severe OHSS in the frozen-thawed cycle transplantation group was significantly lower than that in the fresh cycle transplantation group,the difference was statistically significant(P<0.05);there were no significant differences in abortion rates,ectopic pregnancy rates,and multiple pregnancy rates between the two groups(P>0.05).2 Comparison of different transplantation strategies in the fresh cycle transplantation group(1)The age,infertility years,BMI,bFSH,bE2 and intimal thickness of the three groups were not statistically significant(P>0.05).(2)The multiple pregnancy rate in group A(single blastocyst transfer group)was lower than that in group B(double blastocyst transfer group)and group C(double cleavage stage embryo transfer group)(P<0.05).There was no significant difference in clinical pregnancy rate,embryo implantation rate,miscarriage rate,ectopic pregnancy rate and moderate to severe OHSS incidence among the three groups(P>0.05).Conclusions1.Whole-embryo freeze-thaw cycle transplantation in OHSS high-risk and high-response population could achieve better pregnancy outcomes,and the incidence of OHSS was lower.2.Fresh cycle single blastocyst transplantation in high-response people could effectively reduce the incidence of multiple pregnancy without affecting pregnancy rate.