Clínica EUGIN-Eugin Group, Barcelona, Spain.
Eugin Group, Barcelona, Spain.
Hum Reprod. 2023 Mar 1;38(3):400-407. doi: 10.1093/humrep/dead005.
Does sperm cryopreservation influence the reproductive outcomes of normozoospermic patients in oocyte donation cycles?
After controlling for confounders, the use of cryopreserved semen from normozoospermic patients does not affect pregnancy and live birth rates after elective ICSI.
Sperm cryopreservation by slow freezing is a common practice in ART. While frozen-thawed semen typically presents reduced motility and vitality, its use for ICSI is generally considered adequate in terms of reproductive outcomes. Nevertheless, most studies comparing reproductive outcomes between fresh and cryopreserved sperm include patients with severe male factor (testicular sperm, oligo-, and/or asthenozoospermia) or women of advanced maternal age, where the altered quality of the gametes can partially mask the full effect of freezing/thawing.
STUDY DESIGN, SIZE, DURATION: The study included a retrospective cohort of 7969 couples undergoing their first oocyte donation cycle between January 2013 and December 2019 in one large clinic, using normozoospermic semen from the male partner. All cycles involved elective ICSI, fresh oocytes, and a fresh embryo transfer, either at cleavage or blastocyst stage. Two study groups were established based on the sperm status: fresh (n = 2865) and cryopreserved (n = 5104).
PARTICIPANTS/MATERIALS, SETTING, METHODS: A slow freezing protocol was used for all sperm cryopreservation. Sperm washing, capacitation, and selection prior to ICSI were performed identically for fresh and frozen-thawed samples, using pellet swim-up. Fertilization rate (FR), pregnancy (biochemical and ongoing), and live birth rates were compared between study groups using univariate and multivariate regression analyses.
Male and female age, sperm concentration and motility after ejaculation, and number of oocytes inseminated were similar between cycles using fresh or cryopreserved sperm. Analysis by Student's t-test did not indicate a significant difference in FR between fresh and cryopreserved sperm (P = 0.0591); however, after adjusting for confounders, this difference reached statistical significance: 74.65% FR for fresh (CI 95%: 73.92-75.38) versus 73.66% for cryopreserved sperm (CI 95%: 73.11-74.20), P = 0.0334. The adjusted regression analysis revealed higher odds of biochemical pregnancy when using fresh sperm (odds ratio (OR): 1.143, P = 0.0175), but no significant effects of sperm cryopreservation were observed for ongoing pregnancy (OR: 1.101, P = 0.0983) and live birth (OR: 1.082, P = 0.1805).
LIMITATIONS, REASONS FOR CAUTION: Caution should be exerted when extrapolating these results to different protocols for sperm cryopreservation and selection, or to IVM, advanced maternal age and classical IVF cycles, which were excluded from analysis. Owing to the retrospective nature of the study, some uncontrolled for variables may affect the results.
Sperm cryopreservation does not affect pregnancy and live birth rates in normozoospermic patients, and although it may lower FR s slightly, this would not be clinically relevant. In line with previous studies that included patients with an apparent male or female factor, sperm cryopreservation is a safe and convenient technique.
STUDY FUNDING/COMPETING INTEREST(S): The study received no external funding and all authors have no conflicts of interest to declare.
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精子冷冻保存是否会影响卵胞浆内单精子注射周期中正常精子患者的生殖结局？
在控制混杂因素后，使用正常精子进行精子冷冻保存不会影响选择性 ICSI 后的妊娠和活产率。
在辅助生殖技术中，精子的慢速冷冻保存是一种常见的做法。虽然冷冻-解冻后的精液通常表现出运动能力和活力降低，但在生殖结局方面，其用于 ICSI 通常被认为是足够的。然而，大多数比较新鲜和冷冻精子生殖结局的研究包括严重男性因素（睾丸精子、少精症和/或弱精症）或高龄产妇的患者，在这些情况下，配子质量的改变部分掩盖了冷冻-解冻的全部影响。
研究设计、大小和持续时间：该研究纳入了 2013 年 1 月至 2019 年 12 月期间在一家大型诊所接受首次卵胞浆内单精子注射周期的 7969 对夫妇，使用男性伴侣的正常精子。所有周期均涉及选择性 ICSI、新鲜卵母细胞和卵裂期或囊胚期的新鲜胚胎移植。根据精子状态建立了两个研究组：新鲜组（n=2865）和冷冻组（n=5104）。
参与者/材料、设置、方法：所有精子冷冻保存均采用缓慢冷冻方案。新鲜和冷冻-解冻样本的精子洗涤、获能和选择均使用沉淀泳动法进行，相同。使用单变量和多变量回归分析比较研究组之间的受精率（FR）、妊娠（生化和持续）和活产率。
使用新鲜或冷冻精子的周期中，男性和女性年龄、射精后精子浓度和活力以及授精的卵母细胞数量相似。Student's t 检验分析并未表明新鲜和冷冻精子的 FR 存在显著差异（P=0.0591）；然而，在调整混杂因素后，这种差异达到了统计学意义：新鲜精子的 FR 为 74.65%（CI 95%：73.92-75.38），而冷冻精子的 FR 为 73.66%（CI 95%：73.11-74.20），P=0.0334。调整后的回归分析显示，使用新鲜精子时生化妊娠的可能性更高（优势比（OR）：1.143，P=0.0175），但精子冷冻保存对持续妊娠（OR：1.101，P=0.0983）和活产（OR：1.082，P=0.1805）没有显著影响。
局限性、谨慎的原因：当将这些结果外推到不同的精子冷冻保存和选择方案或体外成熟（IVM）、高龄产妇和经典体外受精（IVF）周期时，应谨慎行事，这些方案被排除在分析之外。由于研究的回顾性性质，一些未控制的变量可能会影响结果。
精子冷冻保存不会影响正常精子患者的妊娠和活产率，尽管它可能会略微降低 FR，但这在临床上并不重要。与包括明显男性或女性因素的患者的先前研究一致，精子冷冻保存是一种安全且方便的技术。
研究资金/利益冲突：该研究未获得外部资金，所有作者均无利益冲突需要声明。
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