Namath Amalia, Flannagan Kerry, Pirtea Paul, Toner James P, Devine Kate
Shady Grove Fertility Center, Rockville, Maryland; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Shady Grove Fertility Center, Rockville, Maryland.
Fertil Steril. 2025 Sep;124(3):487-495. doi: 10.1016/j.fertnstert.2025.04.023. Epub 2025 Apr 23.
To determine the number of mature oocytes required to make at least three euploid blastocysts.
Retrospective cohort study.
All patients at a multicenter assisted reproductive technology practice that warmed vitrified autologous oocytes for in vitro fertilization from 2011 to October 2023.
Warming oocytes.
Number of mature (metaphase II [MII]) oocytes to achieve at least three euploid blastocysts.
A total of 1,041 thaw cycles from 986 patients were analyzed. Patients were stratified by age at vitrification. Measures of ovarian reserve decreased with advancing age, as expected. The number of mature oocytes (MII) banked and euploid blastocysts available decreased as age at vitrification increased. Patients aged 35-40 years used preimplantation genetic testing more than those older than 40 years or younger than 35 years. To optimize the chance of a potential live birth by banking at least three euploid blastocysts, patients aged <35 years at vitrification needed a mean of 15 MII oocytes. This number doubled in patients aged ≥38 years and tripled for patients aged >40 years. We also analyzed potential live birth per number of MII oocytes banked, which also increased with age, with 0.13 expected live births per thawed MII oocyte at the age of <35 years and 0.04 expected live births if older than 40 years at time of oocyte vitrification. Age at vitrification was more influential than indication for vitrification for expected outcome of live birth.
From previously published literature, three euploid blastocysts provided a 93% chance of a child. From our analysis, patients required a mean of 15 mature oocytes to yield at least three euploid blastocysts if they were aged <35 years at time of vitrification. The required number of MII oocytes doubled in patients aged ≥38 years and tripled in those aged ≥40 years, to achieve the same goal. Given our results, we should encourage egg freeze patients to cryopreserve before the age of 38 years. We should also counsel patients that multiple vitrification cycles will likely be required to achieve a high probability of live birth from future oocyte thaws for women aged ≥38 years.
确定获得至少3个整倍体囊胚所需的成熟卵母细胞数量。
回顾性队列研究。
2011年至2023年10月期间，在一家多中心辅助生殖技术机构将玻璃化冷冻的自体卵母细胞解冻用于体外受精的所有患者。
解冻卵母细胞。
获得至少3个整倍体囊胚所需的成熟（中期II [MII]）卵母细胞数量。
共分析了986例患者的1041个解冻周期。患者按冷冻时的年龄分层。正如预期的那样，随着年龄增长，卵巢储备指标下降。冷冻时年龄越大，储存的成熟卵母细胞（MII）数量和可获得的整倍体囊胚数量越少。35至40岁的患者比40岁以上或35岁以下的患者更多地使用植入前基因检测。为了通过储存至少3个整倍体囊胚来优化潜在活产的机会，冷冻时年龄小于35岁的患者平均需要15个MII卵母细胞。这个数字在冷冻时年龄≥38岁的患者中翻倍，在年龄>40岁的患者中增至三倍。我们还分析了每个储存的MII卵母细胞的潜在活产情况，其也随着年龄增长而增加，冷冻时年龄<35岁的患者每个解冻的MII卵母细胞预期活产0.13次，而冷冻时年龄>40岁的患者预期活产0.04次。冷冻时的年龄对活产预期结果的影响大于冷冻指征。
根据先前发表的文献，3个整倍体囊胚有93%的机会生育一个孩子。根据我们的分析，如果冷冻时年龄<35岁，患者平均需要15个成熟卵母细胞才能产生至少3个整倍体囊胚。为了实现相同的目标，冷冻时年龄≥38岁的患者所需的MII卵母细胞数量翻倍，年龄≥40岁的患者所需数量增至三倍。鉴于我们的研究结果，我们应该鼓励卵子冷冻患者在38岁之前进行冷冻保存。我们还应该告知患者，对于年龄≥38岁的女性，可能需要多次冷冻周期才能从未来解冻的卵母细胞中获得较高的活产概率。
