Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Reprogenetics, Livingston, NJ, USA.
Hum Reprod. 2017 Apr 1;32(4):853-859. doi: 10.1093/humrep/dex008.
Can a counseling tool be developed for women desiring elective oocyte cryopreservation to predict the likelihood of live birth based on age and number of oocytes frozen?
Using data from ICSI cycles of a population of women with uncompromised ovarian reserve, an evidence-based counseling tool was created to guide women and their physicians regarding the number of oocytes needed to freeze for future family-building goals.
Elective oocyte cryopreservation is increasing in popularity as more women delay family building. By undertaking elective oocyte freezing at a younger age, women hope to optimize their likelihood of successful live birth(s) using their thawed oocytes at a future date. Questions often arise in clinical practice regarding the number of cryopreserved oocytes sufficient to achieve live birth(s) and whether or not additional stimulation cycles are likely to result in a meaningful increase in the likelihood of live birth. As relatively few women who have electively cryopreserved oocytes have returned to use them, available data for counseling patients wishing to undergo fertility preservation are limited.
STUDY DESIGN, SIZE, DURATION: A model was developed to determine the proportion of mature oocytes that fertilize and then form blastocysts as a function of age, using women with presumably normal ovarian reserve based on standard testing who underwent ICSI cycles in our program from January, 2011 through March, 2015 (n = 520). These included couples diagnosed exclusively with male-factor and/or tubal-factor infertility, as well as cycles utilizing egg donation. Age-specific probabilities of euploidy were estimated from 14 500 PGS embryo results from an external testing laboratory. Assuming survival of thawed oocytes at 95% for women <36 y and for egg donors, and 85% for women ≥36 y, and 60% live birth rate per transferred euploid blastocyst, probabilities of having at least one, two or three live birth(s) were calculated.
PARTICIPANTS/MATERIALS, SETTING, METHOD: First fresh male-factor and/or tubal-factor only autologous ICSI cycles (n = 466) were analyzed using Poisson regression to calculate the probability that a mature oocyte will become a blastocyst based on age. Egg donation cycles (n = 54) were analyzed and incorporated into the model separately. The proportion of blastocysts expected to be euploid was determined using PGS results of embryos analyzed via array comparative genomic hybridization. A counseling tool was developed to predict the likelihood of live birth, based on individual patient age and number of mature oocytes.
This study provides an evidence-based model to predict the probability of a woman having at least one, two or three live birth(s) based on her age at egg retrieval and the number of mature oocytes frozen. The model is derived from a surrogate population of ICSI patients with uncompromised ovarian reserve. A user-friendly counseling tool was designed using the model to help guide physicians and patients.
LIMITATIONS, REASONS FOR CAUTION: The data used to develop the prediction model are, of necessity, retrospective and not based on patients who have returned to use their cryopreserved oocytes. The assumptions used to create the model, albeit reasonable and data-driven, vary by study and will likely vary by center. Centers are therefore encouraged to consider their own blastocyst formation and thaw survival rates when counseling patients.
LIMITATIONS, REASONS FOR CAUTION: Our model will provide a counseling resource that may help inform women desiring elective fertility preservation regarding their likelihood of live birth(s), how many cycles to undergo, and when additional cycles would bring diminishing returns.
STUDY FUNDING/COMPETING INTERESTS: None.
Not applicable.
是否可以开发一种咨询工具，用于希望选择进行卵子冷冻的女性，根据年龄和冷冻的卵子数量预测活产的可能性？
使用具有良好卵巢储备的女性的 ICSI 周期数据，创建了一个基于证据的咨询工具，用于指导女性及其医生关于为未来生育目标冷冻卵子的数量。
随着越来越多的女性推迟生育，选择进行卵子冷冻的人数不断增加。通过在较年轻的时候进行选择性卵子冷冻，女性希望在未来的某个日期使用解冻的卵子优化成功活产的可能性。在临床实践中，经常会出现关于冷冻足够数量的卵子以实现活产的问题，以及是否可能进行额外的刺激周期会显著增加活产的可能性。由于只有相对较少的选择冷冻卵子的女性已经返回使用它们，因此，对于希望进行生育力保存的患者进行咨询的数据有限。
研究设计、规模、持续时间：使用假定具有正常卵巢储备的女性（基于标准测试）的 ICSI 周期数据（n=520），开发了一个模型，用于确定成熟卵子受精并形成囊胚的比例作为年龄的函数。这些周期包括仅诊断为男性因素和/或输卵管因素不孕的夫妇，以及利用卵子捐赠的周期。从外部测试实验室的 14500 个 PGS 胚胎结果中估计特定年龄的整倍体率。假设 36 岁以下的女性和卵子供体的解冻卵子存活率为 95%，36 岁以上的女性为 85%，每个转移的整倍体囊胚的活产率为 60%，计算至少有一个、两个或三个活产的可能性。
参与者/材料、地点、方法：首先分析 466 个新鲜的男性因素和/或输卵管因素仅自身 ICSI 周期，使用泊松回归计算基于年龄的成熟卵子成为囊胚的概率。分别分析卵子捐赠周期（n=54）并将其纳入模型。使用通过阵列比较基因组杂交分析的胚胎的 PGS 结果确定预期的囊胚整倍体比例。根据患者的年龄和成熟卵子的数量，开发了一种预测活产可能性的咨询工具。
本研究提供了一种基于证据的模型，用于根据女性取卵时的年龄和冷冻的成熟卵子数量预测其至少有一个、两个或三个活产的可能性。该模型源自具有良好卵巢储备的 ICSI 患者的替代人群。使用该模型设计了一个用户友好的咨询工具，以帮助指导医生和患者。
局限性、谨慎的理由：用于开发预测模型的数据是回顾性的，并且不是基于已经返回使用冷冻卵子的患者。创建模型所使用的假设虽然合理且基于数据，但因研究而异，也可能因中心而异。因此，鼓励中心在为患者提供咨询时考虑自己的囊胚形成和解冻存活率。
局限性、谨慎的理由：我们的模型将提供一个咨询资源，可能有助于告知希望选择进行选择性生育力保存的女性关于她们的活产可能性、需要进行多少个周期以及进行额外周期会带来什么回报。
研究资金/竞争利益：无。
不适用。
