卵母细胞玻璃化冷冻对临床妊娠结局的影响

Effect of oocyte vitrification on clinical pregnancy outcome

目的探讨卵母细胞玻璃化冷冻在临床应用中的可行性和有效性。方法回顾性分析2012年1月至2018年12月在我院生殖医学中心行卵母细胞玻璃化冷冻复苏后行ICSI的37例患者(共37个周期)的临床资料(观察组)。采用倾向性评分(PSM)匹配方法按1∶5匹配选择同期在本中心行新鲜卵母细胞ICSI的179例患者(共181个周期)为对照组,比较两组患者的受精率、卵裂率、可利用胚胎率、临床妊娠率、种植率、流产率及活产率等妊娠结局。结果(1)两组患者的一般资料比较均无显著性差异(P>0.05)。(2)观察组玻璃化冷冻卵母细胞的复苏率为95.3%(344/361)。两组患者的2PN受精率比较无显著性差异(P>0.05);观察组的2PN卵裂率(94.9%vs.99.0%)、可利用胚胎率(48.1%vs.58.2%)显著低于对照组(P<0.01)。(3)观察组37个周期胚胎移植后,获得20例妊娠,活产19例,分娩25例健康婴儿,无出生缺陷儿发生;对照组181个周期胚胎移植后,获得95例妊娠,活产81例,分娩113例活婴,有1例出生缺陷儿。两组患者的种植率、临床妊娠率、流产率、宫外孕率及活产率比较均无显著性差异(P>0.05)。结论卵母细胞玻璃化冷冻保存可获得较好的复苏率,解冻后行ICSI虽然卵裂率和可利用胚胎率略有下降,但并不影响受精率和妊娠结局。对于取卵日男方因各种原因不能提供精液的女性患者,卵母细胞玻璃化冷冻是一个较好的生育力保存方法。

Objective:To investigate the feasibility and effectiveness of oocyte vitrification in clinical application.Methods:The clinical data 37 patients(37 cycles)who underwent ICSI after oocyte vitrification cryopreservation(observation group)in our reproductive medicine center from January 2012 to December 2018 were retrospectively analyzed.Using the propensity score matching(PSM)method,a 1∶5 match was used to select 179 patients(181 cycles)who underwent ICSI of fresh oocytes transfer in the center during the same period as the control group.The fertilization rate and cleavage rate,available embryo rate,clinical pregnancy rate,implantation rate,abortion rate and live birth rate and other pregnancy outcomes were compared between the two groups.Results:There was no significant difference in the general data between the two groups(P>0.05).The recovery rate of frozen oocytes was 95.3%(344/361)in observation group.There was no significant difference in 2PN fertilization rate between the two groups(P>0.05).The cleavage rate(94.9%vs.99.0%)and transferable embryo rate(48.1%vs.58.2%)in the observation group were significantly lower than those in control group(P<0.01).After 37 cycles of embryo transfer,20 pregnancies,19 live births and 25 healthy infants were obtained without birth defects in the observation group.After 181 cycles of fresh embryo transfer,95 pregnancies,81 live births,113 live births and 1 birth defect were obtained in the control group.There was no significant difference in the implantation rate,clinical pregnancy rate,miscarriage rate,ectopic pregnancy rate and live birth rate between the two groups(P>0.05).Conclusions:Vitrified cryopreservation of oocytes can achieve a satisfactory recovery rate.Although the cleavage rate and available embryo rate decrease slightly after frozen-thawed,the fertilization rate and pregnancy outcome are not affected.Therefore,cryopreservation of oocytes is a proper choice for fertility preservation for couples who cannot provide sperm for insemination on the day of oocyte collection.