61周期卵子玻璃化冷冻临床妊娠结局分析

Analysis of pregnancy outcome of human oocyte vitrification freezing of 61 cycle

目的探讨卵子玻璃化冷冻的可行性、安全性以及年龄对卵子玻璃化冷冻临床妊娠结局的影响。方法回顾分析2012年1月至2019年12月在河北医科大学第二医院生殖医学科行卵子冷冻并解冻的患者59例61周期,女方平均年龄(30.69±5.39)岁。分析61周期患者卵子解冻后复活率、受精率、卵裂率、可利用胚胎率、胚胎种植率、临床妊娠率、流产率、活胎分娩率以及婴儿出生情况;按年龄的不同分2组,A组≤35岁的患者49周期,B组>35岁的患者12周期,统计分析2组卵子冷冻复活率、受精率、卵裂率、可利用胚胎率。统计分析A、B2组胚胎种植率、临床妊娠率、流产率、活胎分娩率。结果61周期共冷冻卵子542枚,移植54周期,7周期未移植(5例全胚冷冻,2例无胚胎移植),卵子复活率95.2%(516/542),2PN受精率84.7%(437/516),2PN卵裂率95.9%(419/437),可利用胚胎率49.7%(217/437),种植率30.6%(34/111),临床妊娠率50.0%(27/54),流产率3.7%(1/27),活胎分娩率48.1%(26/54);冻卵冻胚移植10周期,其种植率33.3%(6/18),临床妊娠率60.0%(6/10),活胎分娩率60.0%(6/9)。卵子玻璃化冷冻累积活胎分娩率59.3%(32/54),共出生38个婴儿,平均体重2886.2 g,其中男婴16例和女婴22例,男女性别比为1∶1.375,未见婴儿出生缺陷。A、B组卵子复活率、受精率、可利用胚胎率、胚胎种植率、临床妊娠率、活胎分娩率比较差异无统计学意义(P>0.05),但A组卵裂率高于B组(P<0.01)。B组胚胎种植率、临床妊娠率、活胎分娩率均有下降的趋势。结论玻璃化冷冻卵子技术是较成熟可行的技术,是临床生育力保存较好的方法,可应用于取卵日任何原因不能提供精子行受精的患者;卵子冷冻尽量在患者≤37岁前进行,以获得较好的卵子复苏率和临床妊娠结局。

Objective To investigate the feasibility,safety and age-related effects on the clinical pregnancy outcomes of oocyte vitrification freezing.Methods A total of 59 patients with 61 cycles who underwent oocyte freezing and thawing in our hospital from January 2012 to December 2019[mean age:(30.69±5.39)years]were enrolled in the study.The the oocyte thaw thaw recovery rate,fertilization rate,cleavage rate,available embryos rate,embryo implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate,and infant birth rate were statistically analyzed.The patients were divided into two groups according to age,group A(≤35 years,at 49 weeks)and group B(>35 years,at 12 cycles),and the oocyte cryosurvival rate,fertilization rate,cleavage rate,and number of embryos available,embryo implantation rate,clinical pregnancy rate,miscarriage rate,and live birth rate were statistically analyzed.Results There were 542 frozen oocytes in 61 cycles,54 cycles were transferred,and 7 cycles were not transferred 5 cases of whole embryo frozen and 2 cases without embryo transfer,and oocyte retrieval rates was 95.2%(516/542),and 2PN fertilization rates was 84.7%(437/516),2PN cleavage rates was 95.9%(419/437),usable embryo rates was 49.7%(217/437),implantation rates was 30.6%(34/111),clinical pregnancy rates was 50.0%(27/54),and miscarriage rate was 3.7%(1/27),live birth rate was 48.1%(26/54).There were 10 cycles of frozen oocyteand frozen embryo in 10 patients,of whom,6 cases were pregnancied,with clinical pregnancy rate and live-fetus delivery rate being 60.0%(6/10),and cumulative live birth rate was 59.3%(32/54).Totally there were 38 babies,including 16 boys and 22 girls,with mean weight being 2886.2g,and no infant birth defects werefound.There were no significant differences in the oocyte retrieval rate,fertilization rate and available embryos rate between the two groups(P>0.05),but the cleavage rate in groups A was significantly higher than that in group B(P<0.01).Moreover the implantation rate of embryos,clinical pregnancy rate,and live birth rate in group B had a decreasing trend.Conclusion The vitrification freezing oocytes is a feasible technique and a good method for clinical fertility preservation,which can be applied to the patients who can not be offered sperm for fertilization for any reason on the oocyte retrieval day,and oocyte freezing should be performed for the patient≤35 years old as much as possible,so as to obtain a better oocyte resuscitation rate and clinical pregnancy outcome.