Freeze-all, oocyte vitrification, or fresh embryo transfer? Lessons from an egg-sharing donation program

Embryo quality is impaired by oocyte vitrification. However, oocyte vitrification is superior to fresh embryo transfer, in terms of pregnancy, and both procedures are inferior to the freeze-all approach.

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Volume 106, Issue 3, Pages 615-622

Authors:

Daniela Paes Almeida Ferreira Braga, D.V.M., Ph.D., Amanda Souza Setti, M.Sc., Rita Cássia Sávio Figueira, Ph.D., Matheus de Castro Azevedo, B.Sc., Assumpto Iaconelli Jr., M.D., Edson Guimarães Lo Turco, D.V.M., Ph.D., Edson Borges Jr., M.D., Ph.D.

Abstract:

Objective

To compare the outcomes of ETs using cryopreserved embryos, cryopreserved oocytes, or fresh embryos.

Design

Observational, cohort study.

Setting

Private university-affiliated fertility center.

Patient(s)

This study included 8,210 mature oocytes obtained from 425 oocyte donors. Of those, 5,440 were used for the donors' own cycles (Fresh Oocyte Cycles Group), and 2,770 were cryobanked for 425 recipients (Banked Donor Egg Group). All of the oocytes were sperm injected, resulting in 4,585 embryos from the donors' own cycles and 2,128 embryos from the recipients’ cycles. For the donor cycles, embryos were either cryopreserved and transferred during a subsequent cycle (Thaw Cycles Group, 3,209 embryos), or they were transferred during a fresh cycle (Fresh Cycles Group, 1,307 embryos). For the recipient cycles, embryos derived from vitrified oocytes were transferred (Vitrified Oocytes Group, n = 425 cycles, 2,128 embryos).

Intervention(s)

Oocyte/embryo vitrification and intracytoplasmic sperm injection.

Main Outcome Measure(s)

Embryo quality, pregnancy, and implantation rates.

Result(s)

Decreased embryo quality and lower rates of blastocyst formation were observed among embryos derived from vitrified oocytes. The highest pregnancy and implantation rates were noted for the Thaw Cycles Group, followed by the Banked Donor Egg Group; the Fresh Cycles Group had the lowest rates.

Conclusion(s)

Oocyte vitrification followed by intracytoplasmic sperm injection leads to lower embryo developmental competence compared with when fresh insemination methods are used. However, pregnancy and implantation rates are higher when embryos are transferred into a “more receptive” endometrium, free of the adverse effects of gonadotropin. Moreover, the freeze-all method leads to exceptional clinical outcomes.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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