Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome

作者：Zi‐Jiang Chen, Yuhua Shi, Yun Sun, Bo Zhang, Xiaoyan Liang, Yunxia Cao, Jing Yang, Jiayin Liu, Daimin Wei, Ning Weng, Lifeng Tian, Cuifang Hao, Dongzi Yang, Feng Zhou, Juanzi Shi, Yongle Xu, Jing Li, Junhao Yan, Yingying Qin, Han Zhao, Heping Zhang, Richard S. Legro · 发表于：New England Journal of Medicine · 年份：2016 · DOI：10.1056/nejmoa1513873 · 被引用次数：833 · 研究领域：Ovarian function and disorders、Reproductive Health and Technologies、Reproductive Biology and Fertility

BACKGROUND: The transfer of fresh embryos is generally preferred over the transfer of frozen embryos for in vitro fertilization (IVF), but some evidence suggests that frozen-embryo transfer may improve the live-birth rate and lower the rates of the ovarian hyperstimulation syndrome and pregnancy complications in women with the polycystic ovary syndrome. METHODS: In this multicenter trial, we randomly assigned 1508 infertile women with the polycystic ovary syndrome who were undergoing their first IVF cycle to undergo either fresh-embryo transfer or embryo cryopreservation followed by frozen-embryo transfer. After 3 days of embryo development, women underwent the transfer of up to two fresh or frozen embryos. The primary outcome was a live birth after the first embryo transfer. RESULTS: Frozen-embryo transfer resulted in a higher frequency of live birth after the first transfer than did fresh-embryo transfer (49.3% vs. 42.0%), for a rate ratio of 1.17 (95% confidence interval [CI], 1.05 to 1.31; P=0.004). Women who underwent frozen-embryo transfer also had a lower frequency of pregnancy loss (22.0% vs. 32.7%), for a rate ratio of 0.67 (95% CI, 0.54 to 0.83; P<0.001), and of the ovarian hyperstimulation syndrome (1.3% vs. 7.1%), for a rate ratio of 0.19 (95% CI, 0.10 to 0.37; P<0.001), but a higher frequency of preeclampsia (4.4% vs. 1.4%), for a rate ratio of 3.12 (95% CI, 1.26 to 7.73; P=0.009). There were no significant between-group differences in rates of other pregnancy an...