Makieva Sofia, Stähli Celine, Xie Min, Gil Ana Velasco, Sachs Maike Katja, Leeners Brigitte
Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland.
Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Front Cell Dev Biol. 2023 Jan 13;11:1095069. doi: 10.3389/fcell.2023.1095069. eCollection 2023.
: Cryopreservation of bipronuclear (2PN) stage zygotes is an integral part of IVF laboratory practice in countries with strict embryo culture legislation. Vitrification of zygotes is compatible with several strategies in infertility treatments holding a freeze-all indication and allows for effective workload management in settings with limited resources. Although it yields high survival rates and clinical outcomes, the ideal timing to commence vitrification of zygotes is elusive while it is empirically practiced in the window between 17 and 21 h post-insemination (hpi). We aimed to deduce the association between pregnancy rate and the time interval from insemination (IVF and ICSI) to vitrification to contribute to the standardization ofzygote cryopreservation. : A retrospective analysis of data on vitrification timings and pregnancy outcomes collected between 2011 and 2019 was performed. All included women received an embryo transfer after warming of vitrified zygotes at the 2PN stage. : A total of 468 embryo transfers were included of which 182 (38.9%) resulted in pregnancy and 286 (61.1%) not. Vitrification was on average performed 18.74 ±0.63 hpi in the pregnant group and 18.62 ± 0.64 hpi in the non-pregnant group (OR 1.36, 95% CI 1.01; 1.83, = 0.045). A multivariate analysis controlling for uterine pathologies, maternal age, AMH, the number of MII oocytes, previous history of pregnancy success, endometriosis, AFC, nicotine intake and male factor infertility showed no predictive value of vitrification timing on pregnancy rate. Three time intervals between insemination and vitrification were defined: 17:00 to 18:00 hpi (Group A), 18:01 to 19:00 hpi (Group B) and 19:01 to 21:00 hpi (Group C). Pregnancy occurred in 40/130 women (30.80%) in Group A, in 115/281 women (40.90%) in Group B and in 27/57 women (47.40%) in Group C. Univariate but not multivariate analysis showed a significantly higher pregnancy rate after the latest time interval between insemination and 2PN vitrification when compared to the earliest (Group C . A, OR 2.03, 95% CI 1.07; 3.84, = 0.031). These findings encourage further investigation on the impact of vitrification timing on clinical outcomes and hold the potential to standardize cryopreservation of zygotes from IVF/ICSI cycles to eventually improve the quality of long-term ART outcomes.
在胚胎培养立法严格的国家，双原核（2PN）期受精卵的冷冻保存是体外受精实验室操作的一个组成部分。受精卵的玻璃化冷冻与多种不孕症治疗策略兼容，适用于有全冻指征的情况，并且有助于在资源有限的环境中有效管理工作量。尽管玻璃化冷冻可产生较高的存活率和临床结局，但受精卵玻璃化冷冻的理想时机仍不明确，目前是在授精后17至21小时（hpi）的时间段内凭经验进行操作。我们旨在推断妊娠率与从授精（体外受精和卵胞浆内单精子注射）到玻璃化冷冻的时间间隔之间的关联，以促进受精卵冷冻保存的标准化。：对2011年至2019年期间收集的玻璃化冷冻时机和妊娠结局的数据进行回顾性分析。所有纳入的女性在2PN期玻璃化冷冻受精卵解冻后接受胚胎移植。：共纳入468次胚胎移植，其中182次（38.9%）妊娠，286次（61.1%）未妊娠。妊娠组玻璃化冷冻平均在授精后18.74±0.63小时进行，未妊娠组为18.62±0.64小时（比值比1.36，95%可信区间1.01；1.83，P = 0.045）。多因素分析控制了子宫病变、产妇年龄、抗缪勒管激素、MII期卵母细胞数量、既往妊娠成功史、子宫内膜异位症、窦卵泡计数、尼古丁摄入和男性因素不育，结果显示玻璃化冷冻时机对妊娠率无预测价值。定义了授精与玻璃化冷冻之间的三个时间间隔：17:00至18:00 hpi（A组）、18:01至19:00 hpi（B组）和19:01至21:00 hpi（C组）。A组130名女性中有40名（30.80%）妊娠，B组281名女性中有115名（40.90%）妊娠，C组57名女性中有27名（47.40%）妊娠。单因素分析而非多因素分析显示，与最早的时间间隔相比，授精与2PN玻璃化冷冻之间最晚的时间间隔后的妊娠率显著更高（C组对比A组，比值比2.03，95%可信区间1.07；3.84，P = 0.031）。这些发现鼓励进一步研究玻璃化冷冻时机对临床结局的影响，并有可能使体外受精/卵胞浆内单精子注射周期的受精卵冷冻保存标准化，最终提高长期辅助生殖技术结局的质量。
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