Check J H, O'Shaughnessy A, Lurie D, Fisher C, Adelson H G
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, USA.
Hum Reprod. 1995 Nov;10(11):3022-7. doi: 10.1093/oxfordjournals.humrep.a135840.
The objective of this study was to determine the mechanism for higher pregnancy rates in oocyte recipients by comparing the pregnancy rates following fresh and frozen embryo transfers in a shared oocyte programme. A prospective study was carried out of 135 matched pairs of donors and recipients who equally share the donors' pool of oocytes. Recipients were subclassified by ovarian function: 69 were in ovarian failure and 66 retained ovarian function. A total of 474 standard in-vitro fertilization cycles using the same ovarian stimulation protocol as the donors were also evaluated. The main outcome measures were the clinical pregnancy and implantation rates for donors and recipients following fresh and frozen embryo transfers. The clinical pregnancy rates per transfer for fresh embryo transfers were 17.5% for donors, 20.4% for recipients with ovarian function and 46.3% for recipients in ovarian failure (P < 0.05). The pregnancy rates for frozen embryo transfers were 15.3% for donors, 17.2% for recipients with ovarian function and 23.8% for recipients in ovarian failure (not significantly different). The implantation rates for fresh transfers were 7.5% for donors, 8.6% for recipients with ovarian function and 15.6% for recipients in ovarian failure (P < 0.05); for frozen cycles, the implantation rates were 5.1, 5.2 and 7.1% respectively (not significantly different). When classified by age and ovarian function, the clinical pregnancy rates per transfer for recipients with ovarian function were 14.0% for those aged > or = 40 and 22.2% for those aged < 40 years. For recipients in ovarian failure, the pregnancy rates were 33.3% for the older group of women and 39.4% for the younger group. A logistic regression analysis found that ovarian function was the only factor to have an independent effect on outcome. The demonstration of higher pregnancy and implantation rates in recipients versus donors following fresh embryo transfer, despite the use of a common pool of oocytes, strongly suggests that the well-known higher fecundity found in recipients is not predominantly related to the use of better quality oocytes. The demonstration of an implantation rate twice as high following fresh versus frozen embryo transfer in recipients with ovarian failure suggests that the frozen embryo is not as hardy as the fresh embryo. Thus, the fact that both the pregnancy and implantation rates in donors were the same with fresh versus frozen embryo transfer suggests that the ovarian stimulation regimen has a negative effect on outcome. However, the clear demonstration of higher pregnancy rates in recipients with ovarian failure compared with those with ovarian function suggests that, in addition, these higher rates may be linked to a superior uterine environment in patients with ovarian failure. Alternatively, the use of gonadotrophin-releasing hormone agonists may have a negative effect on implantation in patients with ovarian function.
本研究的目的是通过比较共享卵母细胞计划中新鲜胚胎移植和冷冻胚胎移植后的妊娠率，来确定卵母细胞接受者妊娠率较高的机制。对135对匹配的供体和受体进行了一项前瞻性研究，这些供体和受体平等共享供体的卵母细胞库。受体根据卵巢功能进行亚分类：69例为卵巢功能衰竭，66例保留卵巢功能。还评估了总共474个使用与供体相同卵巢刺激方案的标准体外受精周期。主要观察指标为新鲜胚胎移植和冷冻胚胎移植后供体和受体的临床妊娠率和着床率。新鲜胚胎移植每次移植的临床妊娠率，供体为17.5%，有卵巢功能的受体为20.4%，卵巢功能衰竭的受体为46.3%（P<0.05）。冷冻胚胎移植的妊娠率，供体为15.3%，有卵巢功能的受体为17.2%，卵巢功能衰竭的受体为23.8%（无显著差异）。新鲜移植的着床率，供体为7.5%，有卵巢功能的受体为8.6%，卵巢功能衰竭的受体为15.6%（P<0.05）；冷冻周期的着床率分别为5.1%、5.2%和7.1%（无显著差异）。按年龄和卵巢功能分类时，有卵巢功能的受体每次移植的临床妊娠率，年龄≥40岁者为14.0%，年龄<40岁者为22.2%。对于卵巢功能衰竭的受体，年龄较大组女性的妊娠率为33.3%，较年轻组为39.4%。逻辑回归分析发现，卵巢功能是唯一对结局有独立影响的因素。尽管使用了共同的卵母细胞库，但新鲜胚胎移植后受体的妊娠率和着床率高于供体，这有力地表明，受体中众所周知的较高生育力并非主要与使用质量更好的卵母细胞有关。卵巢功能衰竭的受体新鲜胚胎移植后的着床率是冷冻胚胎移植后的两倍，这表明冷冻胚胎不如新鲜胚胎耐寒。因此，供体新鲜胚胎移植和冷冻胚胎移植的妊娠率和着床率相同这一事实表明，卵巢刺激方案对结局有负面影响。然而，卵巢功能衰竭的受体与有卵巢功能的受体相比，妊娠率明显更高，这表明，此外，这些较高的妊娠率可能与卵巢功能衰竭患者更好的子宫环境有关。或者，促性腺激素释放激素激动剂的使用可能对有卵巢功能的患者的着床有负面影响。
