Würfel W, Schleyer M, Krüsmann G, Hertwig I V, Fiedler K
Frauenklinik Dr. Wilhelm Krüsmann, München.
Zentralbl Gynakol. 1999;121(9):444-8.
It is reported on a twin pregnancy and parturition of a healthy girl and a healthy boy following the treatment of the mother by intracytoplasmic injection of spermatozoa (ICSI) into cryopreserved and thawed human oocytes (Cryo-Oo). The couple suffered from a primary sterility because of a severe subfertility of the husband and oligomenorrhea with anovulation of the wife. Before the couple contacted our center for the first time, several pretreatments had been carried out, e.g. intrauterine inseminations (IUI) with husband's and donor sperm and one cycle of in vitro fertilization (IVF) with intracytoplasmic sperm injection. This IVF/ICSI-cycle resulted in a tubal pregnancy. It must be noted that the patient showed in each treatment cycle a remarkable tendency to develop ovarian hyperstimulation syndromes (OHSS), even under stimulation with 50 mg clomiphen citrate. In 1997 we started the first treatment cycle for IVF/ICSI with GnIZH-analogues and FSH according to the long protocol. In spite of a low dosage of gonadotropins the patient again developed a impressive multifollicular growth that we decided, together with the couple, only to perform the oocyte retrieval and cryopreserve the collected eggs. For ethic considerations the couple did not consent in the freezing of pronuclear stages. Two months later we performed the transfer-cycle: after thawing of four oocytes, the intracytoplasmic injection of native spermatozoa led to the fertilization of three oocytes and a total of three preimplantation embryos was transferred one day later. Two weeks later the blood level of hCG was 518 IU/ml and an intact twin pregnancy developed. In July 1998, after 36 weeks of gestation, a healthy girl (2540 g) and an healthy boy (2375 g) were delivered by cesarean section. This case report and the experience with further 23 patients (6 pregnancies) demonstrate that ICSI with cryopreserved and thawed oocytes is an effective approach to avoid repetitive oocyte retrievals. The achievable pregnancy rates so far seem to be similar to frozen pronuclear stages, possibly even better. Under the specific regulations of the German Embryo Protection Act (ESchG)--i.e. freezing of embryos not allowed--this technique is worth being pursued with attention.
据报道，一名患有原发性不育症的夫妇，丈夫严重不育，妻子月经过少且无排卵。在这对夫妇首次联系我们中心之前，已经进行了几次预处理，例如用丈夫的精子和供体精子进行宫内人工授精（IUI）以及一个周期的体外受精（IVF）并结合卵胞浆内单精子注射（ICSI）。这次IVF/ICSI周期导致了输卵管妊娠。必须指出的是，即使在使用50毫克枸橼酸氯米芬刺激的情况下，患者在每个治疗周期中都表现出明显的发生卵巢过度刺激综合征（OHSS）的倾向。1997年，我们根据长方案开始了第一个使用促性腺激素释放激素类似物（GnIZH-analogues）和促卵泡生成素（FSH）的IVF/ICSI治疗周期。尽管促性腺激素剂量较低，但患者再次出现了令人印象深刻的多卵泡生长，于是我们与这对夫妇决定仅进行卵母细胞采集并将收集到的卵子冷冻保存。出于伦理考虑，这对夫妇不同意冷冻原核期胚胎。两个月后我们进行了移植周期：在解冻四个卵母细胞后，将天然精子进行卵胞浆内注射，使三个卵母细胞受精，一天后总共移植了三个植入前胚胎。两周后，人绒毛膜促性腺激素（hCG）的血液水平为518国际单位/毫升，随后发展为完整的双胎妊娠。1998年7月，妊娠36周后，通过剖宫产分娩出一个健康女孩（2540克）和一个健康男孩（2375克）。本病例报告以及另外23例患者（6次妊娠）的经验表明，对冷冻和解冻的卵母细胞进行ICSI是避免重复进行卵母细胞采集的有效方法。目前可达到的妊娠率似乎与冷冻原核期胚胎相似，甚至可能更好。在德国《胚胎保护法》（ESchG）的特定规定下——即不允许冷冻胚胎——这项技术值得关注并加以探索。
