Blázquez A, García D, Rodríguez A, Vassena R, Vernaeve V
Clínica EUGIN, Travessera de les Corts 322, 08029 Barcelona, Spain.
Fundació EUGIN, Travessera de les Corts 314, Barcelona 08029, Spain.
Hum Reprod. 2016 Nov;31(11):2549-2553. doi: 10.1093/humrep/dew226. Epub 2016 Sep 8.
Does switching to donor semen after at least three failed oocyte donation (OD) cycles with the partner normozoospermic semen increase the live birth rate in a subsequent OD cycle?
Switching to donor semen after at least three failed OD cycles with the partner normozoospermic semen does not increase the live birth rate.
In some patients, a viable pregnancy cannot be achieved after several OD cycles, despite normal diagnostic findings for the couple. The ESHRE Capri Workshop Group indicates that, in order to improve reproductive outcomes, a semen donation can be offered after three failed ICSI cycles.
STUDY DESIGN, SIZE, DURATION: A retrospective cohort analysis of fourth and fifth OD cycles with either the partner's normozoospermic semen (OD) or double-donation cycles (DD), performed between January 2011 and December 2014 in a private fertility center. These couples did not have a known male factor.
PARTICIPANTS/MATERIALS, SETTING, METHOD: The study included 228 cycles (159 OD and 69 DD). The fertilization method was ICSI in all cycles and embryos were transferred fresh. Fertilization rates were compared between groups using ANOVA while pregnancy outcomes were compared using Chi-square tests. Effect of DD on pregnancy outcomes was further analyzed using a logistic regression model adjusted for recipient's age and BMI, number of embryos transferred, day of embryo transfer and morphological embryo quality score.
There was no difference in live birth rate between the DD and OD groups (38.2 versus 35.8%, P = 0.73), even after adjustment for confounding factors (odds ratio 1.41, 95% confidence interval 0.72, 2.76; P = 0.31). Rates of biochemical pregnancy (52.2 versus 54.1%, P = 0.79), clinical pregnancy (41.2 versus 45.9%, P = 0.51) and ongoing pregnancy (38.2 versus 37.1%, P = 0.87) were not different between the DD and the OD groups, as well as fertilization rate (75.3 versus 75.2%, P = 0.97). The DD and OD groups were comparable at baseline in all demographic and cycle variables analyzed (recipient's BMI, number of transferred embryos and embryo quality) with the exception of recipient's age (42.3 in DD versus 44.1 in OD, P = 0.005), and day of embryo transfer (56.5% of DD and 83.6% of OD embryo transfers were performed on blastocyst stage, P < 0.001); both variables were adjusted for in the multivariate analysis.
LIMITATIONS, REASONS FOR CAUTION: The main limitations of this study are its retrospective nature, the relatively small sample size, the transfer of embryos of different developmental stages and the lack of extensive molecular testing, such as sperm DNA fragmentation test, in normozoospermic patients.
After excluding several causes for the failed OD cycles, the partner's normozoospermic semen was a common factor in all of them. Nevertheless, the change to a donor's semen does not seem to improve the reproductive outcomes in the subsequent cycle.
STUDY FUNDING/COMPETING INTERESTS: No extra-mural funding was obtained for this study. There are no conflicts of interest to declare.
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在使用伴侣正常精子进行至少三个周期的卵母细胞捐赠（OD）失败后，改用供体精液是否会提高随后OD周期的活产率？
在使用伴侣正常精子进行至少三个周期的OD失败后，改用供体精液并不会提高活产率。
在一些患者中，尽管夫妇双方诊断结果正常，但经过几个OD周期仍无法实现存活妊娠。欧洲人类生殖与胚胎学会卡普里研讨会小组指出，为了改善生殖结局，在三个ICSI周期失败后可以提供精液捐赠。
研究设计、规模、持续时间：对2011年1月至2014年12月在一家私立生育中心进行的第四和第五个OD周期进行回顾性队列分析，这些周期使用伴侣的正常精子（OD）或双重捐赠周期（DD）。这些夫妇不存在已知的男性因素。
参与者/材料、环境、方法：该研究包括228个周期（159个OD周期和69个DD周期）。所有周期的受精方法均为ICSI，胚胎新鲜移植。使用方差分析比较各组之间的受精率，使用卡方检验比较妊娠结局。使用逻辑回归模型进一步分析DD对妊娠结局的影响，并对受者年龄、BMI、移植胚胎数量、胚胎移植日和胚胎形态质量评分进行调整。
DD组和OD组的活产率没有差异（38.2%对35.8%，P = 0.73），即使在对混杂因素进行调整后（优势比1.41，95%置信区间0.72，2.76；P = 。31）。DD组和OD组的生化妊娠率（52.2%对54.1%，P = 0.79）、临床妊娠率（41.2%对45.9%，P = 0.51）和持续妊娠率（38.2%对37.1%，P = 0.87）以及受精率（75.3%对75.2%，P = 0.97）均无差异。在所有分析的人口统计学和周期变量（受者BMI、移植胚胎数量和胚胎质量）方面，DD组和OD组在基线时具有可比性，但受者年龄除外（DD组为42.3岁，OD组为44.1岁，P = 0.005），以及胚胎移植日（DD组56.5%的胚胎移植和OD组83.6%的胚胎移植在囊胚期进行，P < 0.001）；这两个变量在多变量分析中均进行了调整。
局限性、谨慎理由：本研究的主要局限性在于其回顾性性质、相对较小的样本量、不同发育阶段胚胎的移植以及在正常精子患者中缺乏广泛的分子检测，如精子DNA碎片检测。
在排除几个OD周期失败的原因后，伴侣的正常精子是所有这些周期中的一个共同因素。然而，改用供体精液似乎并不能改善随后周期的生殖结局。
研究资金/利益冲突：本研究未获得外部资金。没有利益冲突需要声明。
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