CAJ | 학술논문

目的探讨玻璃化冷冻成熟卵母细胞过程中不同冷冻时机及解冻方法对辅助生殖结局的影响.方法回顾性分析郑州大学第一附属医院生殖医学中心2007年5月-2009年5月实施辅助生殖周期中因不同原因接受成熟卵母细胞冷冻及解冻的不孕症患者30例的临床资料,其中女方双侧输卵管梗阻21例,男方无精症9例.将30例患者按照成熟卵母细胞的冷冻时机和解冻方法不同分为3组:A组共5例,取卵后4～5 h冷冻且采用常规方法解冻;B组共9例,取卵后2 h内冷冻且采用常规方法解冻;C组共16例,取卵后2 h内冷冻且采用改良法解冻.所有卵母细胞均采用玻璃化冷冻.冻存2～12个月解冻,存活的卵母细胞行卵母细胞胞质内单精子注射(ICSI)后进行胚胎移植.观察并比较3组患者的辅助生殖结局及孕期随访情况.结果 (1)B组和C组患者的卵母细胞存活率[(65±33)%、(72±23)%]、移植周期率(9/9、16/16)均明显高于A组[(16±17)%、1/5],差异均有统计学意义(P=0.001、0.021);B组与C组分别比较,差异均无统计学意义(P>0.05).C组的平均胚胎种植率[(33±38)%]、临床妊娠率(9/16)均明显高于B组[(4±11)%、1/9],差异均有统计学意义(P=0.033、0.040).(2)C组内采用自身胚胎移植、赠卵胚胎移植及供精胚胎移植者的平均年龄[分别为(28.6±2.1)、(28.0±4.6)、(28.1±3.4)岁]、卵母细胞存活率[分别为(73±25)%、(88±10)%、(66±25)%]、受精率[分别为(84.6±0.9)%、(79.3±2.0)%、(82.8±15.0)%]、胚胎种植率[分别为(20.0±44.7)%、(33.0±0.1)%、(41.6±41.7)%]及临床妊娠率(分别为1/5、3/3、5/8)之间比较,差异均无统计学意义(P>0.05).(3)A组1例患者行胚胎移植,但未妊娠;B组1例临床妊娠,2个月后胚胎停止发育;C组9例临床妊娠,其中1例妊娠4个月流产,8例已顺利分娩5男婴、4女婴,新生儿染色体及发育均正常,每解冻卵母细胞活产率为5.9%(8/135),平均孕周为(39.4±0.9)周,平均新生儿出生体质量为(3574±569)g.结论取卵后2 h内玻璃化冷冻及改良法解冻成熟卵母细胞,可以提高胚胎质量及改善临床妊娠结局. 目的探討玻璃化冷凍成熟卵母細胞過程中不同冷凍時機及解凍方法對輔助生殖結跼的影響.方法迴顧性分析鄭州大學第一附屬醫院生殖醫學中心2007年5月-2009年5月實施輔助生殖週期中因不同原因接受成熟卵母細胞冷凍及解凍的不孕癥患者30例的臨床資料,其中女方雙側輸卵管梗阻21例,男方無精癥9例.將30例患者按照成熟卵母細胞的冷凍時機和解凍方法不同分為3組:A組共5例,取卵後4～5 h冷凍且採用常規方法解凍;B組共9例,取卵後2 h內冷凍且採用常規方法解凍;C組共16例,取卵後2 h內冷凍且採用改良法解凍.所有卵母細胞均採用玻璃化冷凍.凍存2～12箇月解凍,存活的卵母細胞行卵母細胞胞質內單精子註射(ICSI)後進行胚胎移植.觀察併比較3組患者的輔助生殖結跼及孕期隨訪情況.結果 (1)B組和C組患者的卵母細胞存活率[(65±33)%、(72±23)%]、移植週期率(9/9、16/16)均明顯高于A組[(16±17)%、1/5],差異均有統計學意義(P=0.001、0.021);B組與C組分彆比較,差異均無統計學意義(P>0.05).C組的平均胚胎種植率[(33±38)%]、臨床妊娠率(9/16)均明顯高于B組[(4±11)%、1/9],差異均有統計學意義(P=0.033、0.040).(2)C組內採用自身胚胎移植、贈卵胚胎移植及供精胚胎移植者的平均年齡[分彆為(28.6±2.1)、(28.0±4.6)、(28.1±3.4)歲]、卵母細胞存活率[分彆為(73±25)%、(88±10)%、(66±25)%]、受精率[分彆為(84.6±0.9)%、(79.3±2.0)%、(82.8±15.0)%]、胚胎種植率[分彆為(20.0±44.7)%、(33.0±0.1)%、(41.6±41.7)%]及臨床妊娠率(分彆為1/5、3/3、5/8)之間比較,差異均無統計學意義(P>0.05).(3)A組1例患者行胚胎移植,但未妊娠;B組1例臨床妊娠,2箇月後胚胎停止髮育;C組9例臨床妊娠,其中1例妊娠4箇月流產,8例已順利分娩5男嬰、4女嬰,新生兒染色體及髮育均正常,每解凍卵母細胞活產率為5.9%(8/135),平均孕週為(39.4±0.9)週,平均新生兒齣生體質量為(3574±569)g.結論取卵後2 h內玻璃化冷凍及改良法解凍成熟卵母細胞,可以提高胚胎質量及改善臨床妊娠結跼.
목적 탐토파리화냉동성숙란모세포과정중불동냉동시궤급해동방법대보조생식결국적영향.방법 회고성분석정주대학제일부속의원생식의학중심2007년5월-2009년5월실시보조생식주기중인불동원인접수성숙란모세포냉동급해동적불잉증환자30례적림상자료,기중녀방쌍측수란관경조21례,남방무정증9례.장30례환자안조성숙란모세포적냉동시궤화해동방법불동분위3조:A조공5례,취란후4～5 h냉동차채용상규방법해동;B조공9례,취란후2 h내냉동차채용상규방법해동;C조공16례,취란후2 h내냉동차채용개량법해동.소유란모세포균채용파리화냉동.동존2～12개월해동,존활적란모세포행란모세포포질내단정자주사(ICSI)후진행배태이식.관찰병비교3조환자적보조생식결국급잉기수방정황.결과 (1)B조화C조환자적란모세포존활솔[(65±33)%、(72±23)%]、이식주기솔(9/9、16/16)균명현고우A조[(16±17)%、1/5],차이균유통계학의의(P=0.001、0.021);B조여C조분별비교,차이균무통계학의의(P>0.05).C조적평균배태충식솔[(33±38)%]、림상임신솔(9/16)균명현고우B조[(4±11)%、1/9],차이균유통계학의의(P=0.033、0.040).(2)C조내채용자신배태이식、증란배태이식급공정배태이식자적평균년령[분별위(28.6±2.1)、(28.0±4.6)、(28.1±3.4)세]、란모세포존활솔[분별위(73±25)%、(88±10)%、(66±25)%]、수정솔[분별위(84.6±0.9)%、(79.3±2.0)%、(82.8±15.0)%]、배태충식솔[분별위(20.0±44.7)%、(33.0±0.1)%、(41.6±41.7)%]급림상임신솔(분별위1/5、3/3、5/8)지간비교,차이균무통계학의의(P>0.05).(3)A조1례환자행배태이식,단미임신;B조1례림상임신,2개월후배태정지발육;C조9례림상임신,기중1례임신4개월유산,8례이순리분면5남영、4녀영,신생인염색체급발육균정상,매해동란모세포활산솔위5.9%(8/135),평균잉주위(39.4±0.9)주,평균신생인출생체질량위(3574±569)g.결론 취란후2 h내파리화냉동급개량법해동성숙란모세포,가이제고배태질량급개선림상임신결국.
Objective To evaluate the effects on pregnancy outcome of freezing time from oocyte retrieval and thawing method for metaphase Ⅱ human oocytes vitrification. Methods From Mar 2007 to Mar 2009, the clinical outcome of 30 infertile women undergoing vitrified-thawing oocytes of in vitro fertilizationembryo transfer(IVF-ET) in the Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University was studied retrospectively, including 21 women with double fallopian tube obstruction and 9 women's husband azoospermia. All infertile women were divided into three groups, including 5 cases in group A (freezing between 4 and 5 hours from oocyte retrieval and conventional thawing method), 9 cases in group B (freezing within 2 hours from retrieval and conventional thawing method) and 16 cases in group C (freezing within 2 hours from retrieval and improved thawing method). The vitrified oocytes were preserved for 2 months to I year and thawed for Intracytoplasmic sperm injection (ICSI) and embryo transfer. The outcome of IVF and pregnancy were recorded. Results (1) The rates of oocyte survival was (65±33) % in group B and (72±23)% in group C and the rate of transfer cycle was 9/9 in group B and 16/16 in group C, which were all significantly higher than (16±17) % of oocyte survival and 1/5 of transfer cycle in group A (P = 0. 001,0. 021). However, the rate of oocyte survival and transfer cycle between group B and group C did not reach statistical difference (P > 0. 05). The rate of implantation and clinical pregnancy of (33±38) % and 9/16 in group C were significantly higher (4±11)% and 1/9 in group B (P =0. 033,0. 040).(2)The mean age of women in group C were (28.6±2.1) in oneself oocyte, (28.0±4.6) in donor oocyte and (28.1±3.4) in donor sperm. The rate of oocyte survival was (73±25) %, (88±10) % and (66±25) %. The rate of fertilization rate was (84. 6±0. 9) %, (79. 3±2. 0) % and (82. 8±15.0) %. The rate of implantation was (20. 0±44. 7) %, (33. 0±0. 1) % , (41.6±41.7) %. The rate of clinical pregnancy was 1/5 in oneself cycles,3/3 in donor oocyte cycles, 5/8 banked donor sperm cycles in group C. All above clinical parameters were not statistically different (P >0. 05). (3) In group A, one women underwent IVFET and no clinical pregnancy was observed. One women pregnancy was terminated at two months in group B.The clinical pregnancies rate of group C was 9/16, late abortion occurred in 1 woman, the other 8 women underwent term pregnancy, including 5 male infants and 4 female infants. All of infants showed normal Karyotype. Live-birth rates per warmed oocyte was 5.9% (8/135). The mean gestational weeks and birth weight of the infants were (39. 4±0. 9) weeks and (3574±569) g, respectively. Conclusions Embryo quality and clinical outcome of thawing cycles could be significantly improved when oocyte vitrification was performed within 2 hours from oocyte retrieval and improved thawing method.