卵子冷冻技术的临床应用

目的 探讨卵母细胞冷冻技术在临床应用.方法 将258例接受体外受精-胚胎移植(IVF-ET)和单精子卵浆内注射(ICSI)治疗,取卵数≥20枚的258个周期,分为部分卵母细胞冷冻组(简称冻卵组)84个周期和胚胎冷冻组(简称冻胚组)174个周期,比较两组新鲜周期受精率和临床妊娠率.总结了23个卵母细胞冷冻复苏周期及19个移植周期(其中4个周期为捐赠周期)的复苏率,受精率,卵裂率,胚胎种植率,临床妊娠率,比较冻胚组冻胚复苏移植的临床结局.结果 冻卵组和冻胚组新鲜周期的受精率和临床妊娠率差异无统计学意义(P>0.05);19个卵母细胞冷冻复苏的移植周期与56个冷冻胚胎复苏的移植周期的胚胎种植率和临床妊娠率差异亦无统计学意义(P>0.05);卵母细胞冷冻复苏的移植周期妊娠率为47.4%(9/19),其中冻卵捐赠4个移植周期,2例临床妊娠(1例已分娩).结论 对于接受IVF/ICSI治疗的不孕妇女,由卵巢刺激产生的较多卵母细胞,无论是否选择冷冻部分卵母细胞,对其新鲜周期的受精率和妊娠率没有影响;冻卵移植周期与冻胚移植周期的妊娠率差异也无统计学意义;但是卵母细胞冷冻在生育力保存和分享捐赠方面较冻胚具有显著的优势.

Clinical effects of oocyte cryopreservation in assisted reproduction technology

Objective To investigate the clinical effects of oocyte cryopreservation in assistedreproduction technology (ART). Methods 258 patients undergoing retrieval of more than 20 oocytes duringin vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) were divided into 2 groups: Group A,undergoing surplus oocytes cryopreservation (84 cycles) and Group B undergoing embryo cryopreservation(174 cycles) according to the patients' choices. Fertilization rate and clinical pregnancy rate of fresh embryotransfer cycle were compared between these two groups. Twenty-three infertile couples' frozen oocytes werethawed for further ART treatment. Among them, fifteen couples received embryo transfer using their ownfrozen-thawed oocytes, and other four couples used donated frozen-thawed oocytes. The survival rate,fertilization rate, cleavage rate, implantation rate, and clinical pregnancy rate of these 19 cycles werecompared to the outcome of 56 frozen-thawed embryo transfer cycles. Results The fertilization rate of GroupA who underwent IVF was 65.9% , not significantly different from that of Group B who received IVF(66.9%, P > 0. 05 ), and the fertilization rate of Group A who underwent ICSI was 71.6%, notsignificantly different from that of Group B who received ICSI (64.1% , P >0. 05). The clinical pregnancyrate (per embryo transfer cycle) of Group A who received IVF was 52. 9%, not significantly different fromthat of Group B who received IVF (42. 3%, P > 0. 05 ), and the clinical pregnancy rate (per embryotransfer cycle) of Group A who received ICSI was 35.5%, not significantly different from that of Group Bwho received ICSI ( 34.4%, P > 0.05 ). The clinical pregnancy rate of frozen-thawed oocyte group ( perembryo transfer cycle) was 47.4% (9/19). Four couples used donated frozen-thawed oocytes, two of themgot clinical pregnancy and one of them had term delivery. Conclusion For women who undergo retrieval ofmore than 20 oocytes in IVF/ICSI, the clinical outcome of fresh embryo transfer cycle, such as fertilizationrate and clinical pregnancy rate, are not influenced by oocyte cryopreservation and embryocryopreservation. There is no significant difference in the clinical pregnancy rate (per embryo transfer cycle)between frozen-thawed oocyte group and frozen-thawed embryo group. Compared with embryocryopreservation, oocyte cryopreservation has obvious advantages in fertility preservation and oocytedonation.