Manna Claudio, Barbagallo Federica, Sagnella Francesca, Farrag Ashraf, Calogero Aldo E
Biofertility IVF and Infertility Center, 00128 Rome, Italy.
Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
J Clin Med. 2023 Jan 7;12(2):504. doi: 10.3390/jcm12020504.
The protocols commonly used in assisted reproductive technology (ART) consist of long-term embryo culture up to the blastocyst stage after the insemination of all mature oocytes, the freezing of all the embryos produced, and their subsequent transfer one by one. These practices, along with preimplantation genetic testing, although developed to improve the live birth rate (LBR) and reduce the risk of multiple pregnancies, are drawing attention to the possible increase in obstetric and perinatal risks, and adverse epigenetic consequences in offspring. Furthermore, ethical-legal concerns are growing regarding the increase in cryopreservation and storage of frozen embryos. In an attempt to reduce the risk associated with prolonged embryo culture and avoid embryo storage, we have chosen to inseminate a limited number of oocytes not exceeding the number of embryos to be transferred, after two days or less of culture. We retrospectively analyzed 245 ICSI cycles performed in 184 infertile couples with a female partner aged ≥40 from January 2016 to July 2021. The results showed a fertilization rate of 95.7%, a miscarriage rate of 48.9%, and a LBR of 10% with twin pregnancies of 16.7%. The cumulative LBR in our group of couples was 13%. No embryos were frozen. In conclusion, these results suggest that oocyte selection and embryo transfer at the cleaving stage constitute a practice that has a LBR comparable to that of the more commonly used protocols in older women who have reduced ovarian reserve.
辅助生殖技术（ART）中常用的方案包括：在所有成熟卵母细胞受精后进行长期胚胎培养直至囊胚阶段，冷冻所产生的所有胚胎，并随后逐个进行移植。这些做法，连同植入前基因检测，尽管是为了提高活产率（LBR）和降低多胎妊娠风险而开发的，但却引发了人们对产科和围产期风险可能增加以及后代不良表观遗传后果的关注。此外，关于冷冻胚胎冷冻保存和储存增加的伦理法律问题也日益凸显。为了降低与延长胚胎培养相关的风险并避免胚胎储存，我们选择在培养两天或更短时间后，对不超过拟移植胚胎数量的有限数量的卵母细胞进行受精。我们回顾性分析了2016年1月至2021年7月在184对女性伴侣年龄≥40岁的不育夫妇中进行的245个ICSI周期。结果显示受精率为95.7%，流产率为48.9%，活产率为10%，双胎妊娠率为16.7%。我们这组夫妇的累积活产率为13%。没有胚胎被冷冻。总之，这些结果表明，在卵裂阶段进行卵母细胞选择和胚胎移植构成了一种活产率与卵巢储备减少的老年女性中更常用方案相当的做法。
