Spring Samantha, Tsai Shelun, Verzani Zoe, Spandorfer Steven
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
Fertil Steril. 2024 Dec;122(6):1048-1054. doi: 10.1016/j.fertnstert.2024.07.035. Epub 2024 Aug 6.
To determine the optimal number of fresh donor oocytes to expose to sperm for patients who want to prioritize reducing surplus embryos while preserving the live birth rate.
Cross-sectional study.
University.
PATIENT(S): Patients who underwent their first in vitro fertilization of fresh donor oocytes at a single academic institution between January 2013 and November 2022. Patients were excluded if they used a directed oocyte donor, donor aged >32 years, gestational carrier, surgically retrieved sperm, or preimplantation genetic testing.
INTERVENTION(S): Number of fresh mature donor oocytes fertilized via intracytoplasmic sperm injection.
MAIN OUTCOME MEASURE(S): The primary outcome was the number of cryopreserved supernumerary blastocysts. The number of supernumerary blastocysts was defined as the number of blastocysts remaining after the first live birth, or if the patient did not have a live birth, the number of supernumerary blastocysts was determined by the number of blastocysts remaining after the last transfer cycle. The Kruskal-Wallis rank sum test was used to determine differences in number of supernumerary blastocysts.
RESULT(S): A total of 543 patients who underwent 750 embryo transfer cycles using fresh donor oocytes were included. The average recipient age was 42.9 ± 3.8 years, and the average oocyte donor age was 26.6 ± 3.0 years. For our cohort, patients received a median of 10 (interquartile range [IQR], 8-14) mature donor oocytes; 8 (IQR, 6-11) were injected with sperm, 4 (IQR, 3-6) usable embryos were developed, and 2 (IQR, 0-5) supernumerary blastocysts remained. Patients were then divided into four quartiles on the basis of the number of mature donor oocytes received (≤7, 8-10, 11-14, or ≥15). There was a significant increase in the median number of cryopreserved supernumerary blastocysts as the number of mature donor oocytes exposed to sperm increased (1 vs. 2 vs. 3 vs. 6 blastocysts in the first, second, third, and fourth quartiles, respectively). There were no statistically significant differences in live birth rates between the quartiles.
CONCLUSION(S): The number of supernumerary blastocysts significantly increased as more mature donor oocytes were exposed to sperm. This study can serve as a counseling tool for patients with concerns regarding excess cryopreserved embryos when using fresh donor oocytes.
对于希望在保持活产率的同时优先减少剩余胚胎的患者，确定用于受精的新鲜供体卵母细胞的最佳数量。
横断面研究。
大学。
2013年1月至2022年11月期间在单一学术机构接受首次新鲜供体卵母细胞体外受精的患者。如果患者使用定向卵母细胞供体、供体年龄>32岁、妊娠载体、手术获取的精子或植入前基因检测，则排除在外。
通过卵胞浆内单精子注射受精的新鲜成熟供体卵母细胞数量。
主要结局是冷冻保存的多余囊胚数量。多余囊胚的数量定义为首次活产后剩余的囊胚数量，或者如果患者没有活产，则多余囊胚的数量由最后一个移植周期后剩余的囊胚数量确定。使用Kruskal-Wallis秩和检验来确定多余囊胚数量的差异。
共纳入543例使用新鲜供体卵母细胞进行750个胚胎移植周期的患者。受者平均年龄为42.9±3.8岁，卵母细胞供体平均年龄为26.6±3.0岁。对于我们的队列，患者接受的成熟供体卵母细胞中位数为10个（四分位间距[IQR]，8 - 14）；8个（IQR，6 - 11）注射了精子，4个（IQR，3 - 6）发育成可用胚胎，2个（IQR，0 - 5）多余囊胚留存。然后根据接受的成熟供体卵母细胞数量将患者分为四个四分位数组（≤7、8 - 10、11 - 14或≥15）。随着暴露于精子的成熟供体卵母细胞数量增加，冷冻保存的多余囊胚中位数显著增加（第一、第二、第三和第四四分位数组分别为1个、2个、3个和6个囊胚）。各四分位数组之间的活产率无统计学显著差异。
随着更多成熟供体卵母细胞暴露于精子，多余囊胚的数量显著增加。本研究可为使用新鲜供体卵母细胞时担心冷冻保存胚胎过多的患者提供咨询工具。
