The Effect Of In Vitro Fertilization And Embryo Transfer On The Safety Of Mother And Infant

During a fresh IVF-ET cycle, exogenous gonadotropins are adm inistered to promote the development of multiple follicles resulting in estradiol levels that can be 10-20 times greater than physiologic status, thus the normal endocrine environment is affected. There have been increasing concerns that a disrupted endocrine environment may deteriorate the responses of gam ete/embryo, disturb the growth of the fetus.It is shown that even singletons after AR T are at increas ed risk for low birth weight(LBW), and singletons conceived through fresh ET have lower birth weight and more LBW than those through frozen ET. Pandey et al. concluded that the risks of obstetric and perinatal complications are higher in singleton pregnancies after IVF/ICSI when compared with natural conception, which m ay be related to COH, in vitro culture technique, sperm injection intracytoplasmic(ICSI), embryo freezing technology an d so on, but there is no defin ite conclusion. There have been increasing concerns the effect of ART on maternal and infant pregnancy outcome and offspring safety.ObjectiveTo investigate the effects of high estrogen environment and embryo freezin g technology on maternal and neonatal outcomes and neonatal weight in IVF.Methods 1. S tudy ObjectThe clinical data of patients treated with IVF-ET were retrospective analyzed in Reproductive Center of the Third Af filiated Hospital of Zhengzhou University, from January 2008 to March 2015. All cycles of e mbryo transfer was selected, including fresh embryo transfer cycle(Fresh-ET group) 6941 cases and frozen embryo transfer cycle( FET group)16253 cases. This study included 1336 patients who perform ed fresh embryo transfer and delivered singleton full-term newborn, and according to the level of serum E2 on HCG day, divided into high estrogen group(High-E2) 587 cases and low estrogen group(Low-E2) 749 cases; 640 patients who canceled transplant in fresh IVF cycle performmed frozen thawed embryo transfer a nd delivered singleton term infants(FET-1 group) during the sam e period; Naturally conceived singletons from the same hospital served as a contro l group 668 cases, m atched to the fresh ET group by a ratio of 1:2. 2. MethodIn Fresh-ET group and FET group, the pa tient age, clinical pregnancy rate, ectopic pregnancy incidence, miscarriage rate, early abortion rate, premature delivery rate, live birth rate, pregnancy com plications(including pregnancy with gestational diabetes mellitus(G DM), gestational hypertension disease) incidence rate, malformation rate were observed.In High-E2, Low-E2, FET-1, and Natural pregnancy group, the patient age, pre pregnancy body mass index(body mass index, BMI=weight/height2(kg/m2), duration of infertility, basal FSH(b FSH), the dosag e of Gn, the number of retrieved oocytes, the number of 2pns, the num ber of good qual ity embrys, delivery gestational age, neonatal birth weight, the incidence rate of LBW and SGA(Birth weight lower than the same gestational age under the weight of tenth percentile) were observed. 3. S tatistical methodsUsing SPSS 21.0 software for statistical an alysis,compare the measurement data with variance analysis, com parison between the groups use t-test; Count data ratecompared with χ2 test,Kruskal-Wallis is used when the measurement data is not in the normal distribution,the results using m ean add /reduce standard deviation or rate(%),a = 0.05 for inspection level.Results1. The compare of Fresh-ET group and FE T group, the clinical pregnancy rate, ectopic pregnancy occurred rate, abortion rate, early abortion incidence, the incidence of premature rate, pregnancy com plications occurrence rate, live birth rate, fetal malformation rates of two groups were respectively 47.7% and 47.8%, 2.4% and 1.8%, 11.8% and 8.1%, 19.7% and 15.0%, 8.3% and 4.4%, 0.7% and 0.8%. The clinical pregnancy rate of two groups is not signi ficant difference(P>0.05); the ectopic pregnancy rate, abortion rate, premature delivery rate, pregnancy complication rate of Fresh-ET group was higher than that of the FET group, the difference is statistically significant(P<0.05); The live birth rate of FET group was higher than the Fresh-ET group, the difference was statistically significant(P<0.05).2. Comparison of High-E2 group, Low-E2 group, FET-1 group and natural pregnancy group, the neonatal birth weight of four groups were 33259.2 ±410.9、3262.9±421.5、3499.2±546.5、3467.0±521.7. FET-1 group, natural pregnancy group neonatal birth weight were higher than High-E2 group, Low-E2 group, the difference was statis tically significant(P<0.05), but there was no significant difference between FET-1 group and natural pregnancy group(P>0.05); The incidence rate of LBW of four groups we re 3.2%, 1.2%, 1.4%, 0.9% and High-E2 group was higher than that of Low-E2 group, FET-1 group and natural pregnancy group, the difference was statis tically significant(P<0.05), but there was no significant difference between Low-E2 group, FET-1 group and natural pregnancy group(P>0.05); The incidence rate of SGA of four groups were 8.3%, 4.8% 3.4%, 4%, High-E2 group was higher than that of Low- E2 group, FET-1 group and Natural pregnancy group, the dif ference was statistically significant(P<0.05), but there was no significant difference between Low-E2 group, FET-1 group and natural pregnancy group(P > 0.05).Conclusions1. There was no dif ference in pregnancy rate between Fresh-ET group and FET group, but the ectopic pregnancy rate, ab ortion rate, prem ature delivery rate, pregnancy complication rate of Fresh-ET group was higher than that of the FET group, and the live birth rate in FET group is higher than Fresh-ET group;2. Embryo freezing technology does not affect the birth weight of the newborns, and compared with the fresh ET cycle, FET increases the birth we ight of the newborns;3. The high estrogen level on HCG day affects the birth weight of newborn babies in fresh ET cycle, and the incidence rate of SGA and LBW was increased(Especially when the blood HCG value > 3886pg/ml).