Borini Andrea, Cattoli Monica, Bulletti Carlo, Coticchio Giovanni
Tecnobios Procreazione, Bologna, Italy.
Ann N Y Acad Sci. 2008 Apr;1127:49-58. doi: 10.1196/annals.1434.012.
The assessment of the standard for success of in vitro fertilization (IVF) treatment is an arduous task. Clinical efficiency and safety of a given procedure should represent fundamental tools for objective comparison. However, differences in patient populations, laboratory protocols, and expression of clinical data make the analysis of different studies and strategies very difficult. Formulation of the standard for success through the cumulative delivery rate per cycle of stimulation is a very attractive option because it includes the essential contribution of frozen embryos, which can represent 30-40% of all deliveries, while taking into account the need to minimize the proportion of pharmacological and surgical treatments. Embryo cryopreservation may be applied at different postinsemination stages. Larger and more detailed sets of data are available for day 2 embryo freezing, which allows cumulative delivery rates of 50-60% in good prognosis patients. In the last few years, novel freezing methods have improved the overall efficiency of oocyte cryopreservation. Especially in contexts afflicted by legal restrictions to embryo cryo- preservation, this form of preservation has started to have an impact on the IVF standard of success, generating cumulative pregnancy rates approaching 50%. Despite having been applied systematically by some IVF programs for only a few years, oocyte freezing already competes in efficiency with pronuclear-stage cryopreservation, and it does not appear unrealistic to predict that in the future it will challenge the dominance of embryo cryopreservation as the preferred form of conservation.
评估体外受精（IVF）治疗的成功标准是一项艰巨的任务。给定程序的临床效率和安全性应是进行客观比较的基本依据。然而，患者群体、实验室方案以及临床数据表达方式的差异使得对不同研究和策略的分析变得非常困难。通过每个刺激周期的累积分娩率来制定成功标准是一个非常有吸引力的选择，因为它考虑到了冷冻胚胎的重要贡献，冷冻胚胎可占所有分娩的30%-40%，同时也考虑到了尽量减少药物和手术治疗比例的必要性。胚胎冷冻保存可应用于授精后的不同阶段。关于第2天胚胎冷冻的数据集更大且更详细，这使得预后良好的患者累积分娩率可达50%-60%。在过去几年中，新型冷冻方法提高了卵母细胞冷冻保存的整体效率。特别是在胚胎冷冻保存受到法律限制的情况下，这种保存形式已开始对IVF成功标准产生影响，累积妊娠率接近50%。尽管卵母细胞冷冻仅被一些IVF项目系统应用了几年，但它在效率上已经可以与原核期冷冻保存相竞争，并且预测其未来将挑战胚胎冷冻保存作为首选保存形式的主导地位似乎并非不切实际。
