Zhu Xiuxian, Ye Jing, Fu Yonglun
Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Assisted Reproduction, Shanghai Ninth Peoples Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Ann Transl Med. 2021 Apr;9(7):539. doi: 10.21037/atm-20-1112.
Women with premature ovarian insufficiency (POI) are often discouraged from using autologous oocytes; however, some patients have a strong desire to be genetically linked to their offspring. In the present study, we aimed to estimate cumulative pregnancy outcomes following frozen-embryo transfer (FET) in POI patients who could obtain viable embryos with their eggs during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments.
In this matched-retrospective cohort study, only patients undergoing IVF/ICSI treatments with a freeze-all strategy were screened, and 103 POI patients were matched with 515 normal controls in terms of the same number of viable embryos obtained at the same age. The primary outcome was the cumulative clinical pregnancy rate (CCPR) following FET per patient.
Patients with POI and normal ovarian reserve had comparable CCPRs of 62.14% (64/103) and 65.24% (336/515), respectively (P=0.547), and no statistical difference was found in the cumulative live-birth rate (CLBR) between the study group (43.69%) and the control group (53.01%). Based on binary logistic regression, the CCPR and CLBR showed no association with the type of ovarian function (POI or normal ovarian reserve). The number of embryos per transfer and the sum of all viable embryos per patient were positively associated with the CCPR and CLBR. The clinical pregnancy rate (CPR) per FET cycle was 38.17% for the study group and 52.1% for the control group, while the CPRs per oocyte retrieval cycle in the 2 groups were 11.25% and 69.9%, respectively, and both were statistically different (P<0.05). Moreover, POI patients had a lower implantation rate (27.8% 37.94%) and a higher early miscarriage rate per transfer (26.76% 15%) than patients in the control group (P<0.05).
Cumulative pregnancy outcomes following FET were reasonable for POI patients using viable embryos derived from autologous oocytes through repeated oocyte retrievals.
卵巢早衰（POI）女性常因顾虑而不愿使用自体卵母细胞；然而，一些患者强烈希望与自己的后代有基因联系。在本研究中，我们旨在评估卵巢早衰患者在体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗期间能用自己的卵子获得可存活胚胎，之后进行冻融胚胎移植（FET）后的累积妊娠结局。
在这项配对回顾性队列研究中，仅筛选采用全冷冻策略进行IVF/ICSI治疗的患者，103例卵巢早衰患者与515例正常对照者按相同年龄获得相同数量可存活胚胎进行配对。主要结局是每位患者FET后的累积临床妊娠率（CCPR）。
卵巢早衰患者和卵巢储备功能正常者的CCPR分别为62.14%（64/103）和65.24%（336/515），二者相当（P = 0.547），研究组（43.69%）和对照组（53.01%）的累积活产率（CLBR）无统计学差异。基于二元逻辑回归分析，CCPR和CLBR与卵巢功能类型（卵巢早衰或卵巢储备功能正常）无关。每次移植的胚胎数和每位患者所有可存活胚胎总数与CCPR和CLBR呈正相关。研究组每次FET周期的临床妊娠率（CPR）为38.17%，对照组为52.1%，而两组每个取卵周期的CPR分别为11.25%和69.9%，二者均有统计学差异（P<0.05）。此外，卵巢早衰患者每次移植的着床率（27.8%对37.94%）和早期流产率（26.76%对15%）均低于对照组患者（P<0.05）。
对于卵巢早衰患者，通过反复取卵利用自体卵母细胞获得的可存活胚胎进行FET后的累积妊娠结局是合理的。
