Gallardo Miguel, Goncalves Ines, Redondo Jorge, Soares Ana Paula, Garrido Nicolas, Metello Jose L
IVIRMA Global Research Alliance, Ginemed Lisbon, IVF Laboratory, Lisbon, Portugal.
Universidade Lusofona, Embryology and Human Reproduction, Lisbon, Portugal.
Fertil Steril. 2025 Mar;123(3):448-456. doi: 10.1016/j.fertnstert.2024.09.041. Epub 2024 Sep 29.
To assess the impact of below-benchmark (95%-100%) donor-oocyte survival rates on vitrification/warming in the laboratory and clinical outcomes of recipient cycles.
Retrospective cohort study.
We analyzed 12,690 vitrified-warmed donor-oocyte recipient cycles performed from 2018-2022.
All cycles analyzed used exclusively vitrified/warmed donor oocytes. The cycles were grouped according to the survival rate experienced: benchmark 95%-100%; competence 85%-95%; below competence 70%-85%; poor 50%-70%; and very poor <50%.
The primary endpoint of the study was the total usable blastocyst rate per 2 pronuclear (2PN) zygote. Secondary endpoints were the fertilization rate, the live birth rate after the first single blastocyst transfer, and the cumulative live birth rate.
The mean number of warmed oocytes per intracytoplasmic sperm injection (ICSI) cycle was 11.4 ± 3.2, with a mean survival rate of 89.1%. More oocytes per cycle were consumed in the lower survival groups, yet the total number of oocytes available for ICSI was smaller in the below-competence, poor, and very poor survival groups. The total usable blastocyst rate was lower in the lower survival groups (benchmark: 48.9%; competence: 47.0%, below competence: 46.0%; poor: 43.6%; and very poor: 43.6%), as well as the fertilization rates (benchmark: 76.8%; competence: 76.6%, below competence: 75.6%; poor: 74.7%; and very poor:75.5%). The adjusted relative risk (aRR) of live birth rate of the first embryo transferred was equal to the benchmark survival group in all the lower survival groups (benchmark: 40.9%; competence: aRR = 0.986, 95% confidence interval [CI]: 0.931-1.045; below-competence: aRR = 0.992, 95% CI: 0.929-1.059; poor: aRR = 1.103, 95% CI: 1.009-1.207; and very poor: aRR = 1.169, 95% CI: 0.963-1.419). The cumulative live birth rate decreased in lower survival groups compared with benchmark survival (benchmark: 79.2%; competence: aRR = 0.988, 95% CI: 0.961-1.015; below competence: aRR = 0.911, 95% CI: 0.880-0.944; poor: aRR = 0.802, 95% CI: 0.757-0.851; and very poor: aRR = 0.793, 95% CI: 0.693-0.907). The lower cumulative rates maintained in a subanalysis with equal metaphase-II available for ICSI (benchmark: 69.5%; competence: aRR = 0.909, 95% CI: 0.827-1.000; below competence: aRR = 0.942, 95% CI: 0.848-1.046; poor: aRR = 0.833, 95% CI: 0.7386-0.941; and very poor: aRR = 0.873, 95% CI: 0.695-1.097) CONCLUSION: Lower donor-oocyte cryo-survival rates have a moderate negative impact on the blastocyst utilization rate per 2PN zygote, fertilization rate, and the cumulative live birth rates of a donation cycle, even after adjusting for equal metaphase-II oocytes available for ICSI. Nonetheless, the surviving oocytes of a cohort seem to maintain a high competence level, with very similar laboratory outcomes, irrespective of the cohort's survival rates, as well as equal implantation potential of the resulting blastocysts.
评估低于基准水平（95%-100%）的供体卵母细胞存活率对实验室玻璃化/解冻以及受体周期临床结局的影响。
回顾性队列研究。
我们分析了2018年至2022年期间进行的12690个玻璃化-解冻供体卵母细胞受体周期。
所有分析的周期均仅使用玻璃化/解冻的供体卵母细胞。根据经历的存活率将周期分组：基准水平95%-100%；胜任水平85%-95%；低于胜任水平70%-85%；较差水平50%-70%；以及非常差水平<50%。
研究的主要终点是每个双原核（2PN）受精卵的总可用囊胚率。次要终点是受精率、首次单囊胚移植后的活产率以及累积活产率。
每个卵胞浆内单精子注射（ICSI）周期中解冻卵母细胞的平均数量为11.4±3.2，平均存活率为89.1%。较低存活率组每个周期消耗的卵母细胞更多，但在低于胜任水平、较差和非常差存活率组中可用于ICSI的卵母细胞总数较少。较低存活率组的总可用囊胚率较低（基准水平：48.9%；胜任水平：47.0%，低于胜任水平：46.0%；较差水平：43.6%；非常差水平：43.6%），受精率也较低（基准水平：76.8%；胜任水平：76.6%，低于胜任水平：75.6%；较差水平：74.7%；非常差水平：75.5%）。在所有较低存活率组中，首次移植胚胎的活产率的调整相对风险（aRR）与基准存活组相当（基准水平：40.9%；胜任水平：aRR = 0.986，95%置信区间[CI]：0.931-1.045；低于胜任水平：aRR = 0.992，95% CI：0.929-1.059；较差水平：aRR = 1.103，95% CI：1.009-1.207；非常差水平：aRR = 1.169，95% CI：0.963-1.419）。与基准存活组相比，较低存活率组的累积活产率降低（基准水平：79.2%；胜任水平：aRR = 0.988，95% CI：0.961-1.015；低于胜任水平：aRR = 0.911，95% CI：0.880-0.944；较差水平：aRR = 0.802，95% CI：0.757-0.851；非常差水平：aRR = 0.793，95% CI：0.693-0.907）。在对可用于ICSI的中期II期卵母细胞数量相等的亚分析中，较低的累积率仍然存在（基准水平：69.5%；胜任水平：aRR = 0.909，95% CI：0.827-1.000；低于胜任水平：aRR = 0.942，95% CI：0.848-1.046；较差水平：aRR = 0.833，95% CI：0.7386-0.941；非常差水平：aRR = 0.873，95% CI：0.695-1.097）
较低的供体卵母细胞冷冻存活率对每个2PN受精卵的囊胚利用率、受精率以及捐赠周期的累积活产率有中度负面影响，即使在对可用于ICSI的中期II期卵母细胞数量进行调整之后也是如此。尽管如此，一组中的存活卵母细胞似乎保持着较高的胜任水平，无论该组的存活率如何，实验室结局都非常相似，并且所产生囊胚的着床潜力也相等。
