卵母细胞玻璃化冷冻在临床中的应用

Clinical application of vitrification freezing of oocytes

目的评价取卵日取精失败周期进行卵母细胞冷冻是否影响胚胎质量及发育潜力。方法收集2014年1月至2017年12月在浙江大学医学院附属邵逸夫医院生殖中心因男方严重少弱精子症或者无精子症取卵日取精失败或者无法获得足够精子而行卵母细胞玻璃化冷冻的30例患者作为冷冻组。选取同期的220例新鲜卵母细胞的患者作为新鲜组。回顾性比较两组的受精率、优胚率、妊娠率、着床率及活产率。结果卵母细胞复苏存活率为91.4%(180/197)。冷冻组中24例行胚胎移植,妊娠14例,新鲜组31例行胚胎移植,妊娠18例。冷冻组两原核(2PN)的受精卵数、胚胎数及优质胚胎数明显少于新鲜组,分别为:(3.7±2.5比7.3±4.8)、(3.3±2.5比7.2±4.8)及(1.2±1.8比2.9±2.7)(均P<0.05)。冷冻组受精率77.2%(115/149)和优质胚胎率36.6%(37/101)均低于新鲜组,分别为:77.6%(1637/2109)及40.9%(651/1591)(P>0.05)。冷冻组妊娠率58.3%(14/24)高于新鲜组58.1%(18/31),每成熟卵母细胞着床率和每成熟卵母细胞活产率为10.8%(15/138)和10.8%(15/138),均高于新鲜组9.6%(21/218)及8.7%(19/218),差异均无统计学意义(均P>0.05)。结论卵母细胞玻璃化冷冻保存可能导致胚胎的质量有所下降,但是胚胎的发育潜力仍是可观的,并可能获得比新鲜组更高的妊娠率、着床率和活产率。

Objective To evaluate the effect of oocyte vitrification on embryo quality and developmental potential.Methods From January 2014 to December 2017,30 cases of oocytes vitrification in the reproductive center of Sir Run Run Shaw hospital were collected as the frozen group,due to failure of sperm extraction or inability to obtain sufficient sperm at the ovum pick-up-day because of oligoospermia or azoospermia.220 cases of fresh oocytes from the same period were selected as the fresh group.The fertilization rate,embryo rate,pregnancy rate,implantation rate and live birth rate of the two groups were compared retrospectively.Results The survival rate of oocyte resuscitation was 91.4%(180/197).In the frozen group,24 cases were transferred with 14 pregnancies,while in the fresh group,31 cases were transferred with 18 pregnancies.The number of 2PN fertilized eggs,2PN embryos and 2PN high-quality embryos in the frozen group was significantly lower than that in the fresh group(3.7±2.5 vs 7.3±4.8),(3.3±2.5 vs 7.2±4.8),and(1.2±1.8 vs 2.9±2.7)(all P<0.05).The fertilization rate of the frozen group was 77.2%(115/149)and the high-quality embryo rate was 36.6%(37/101),lower than that of the fresh group 77.6%(1637/2109)and 40.9%(651/1591)(P>0.05).The pregnancy rate of the frozen group was 58.3%(14/24)higher than that of the fresh group 58.1%(18/31),the implantation rate of each mature oocyte and the live birth rate of each mature oocyte were 10.8%(15/138)and 10.8%(15/138),both higher than that of the fresh group 9.6%(21/218)and 8.7%(19/218)(all P>0.05).Conclusions Vitrification cryopreservation of oocytes may lead to a decrease in embryo quality,but embryo development potential is still considerable.Higher pregnancy rate,implantation rate and live birth rate may be obtained.