Development of a Model to Estimate the Optimal Number of Oocytes to Attempt to Fertilize During Assisted Reproductive Technology Treatment.
Development of a Model to Estimate the Optimal Number of Oocytes to Attempt to Fertilize During Assisted Reproductive Technology Treatment.
复制标题
DOI：
10.1001/jamanetworkopen.2022.49395
复制
发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Rossi, Brooke V.
中科院分区：
文献类型：
--
作者：
Correia, Katharine F. B.;Missmer, Stacey A.;Weinerman, Rachel;Ginsburg, Elizabeth S.;Rossi, Brooke V.
这项诊断研究估计了辅助生殖技术治疗期间尝试受精的最佳卵母细胞数量。在辅助生殖技术周期中应将多少卵母细胞暴露于精子，以最大限度地减少未使用胚胎的数量，同时优化活产的可能性？在这项基于国家登记的诊断研究中，在 38 岁以下患者的 66.2% 周期中，并非所有取出的卵母细胞都可以接触精子，以最大程度地减少未使用胚胎的数量，同时优化活产概率。这些发现表明，开发的预测工具可以减少未使用的胚胎数量，并立即解决当前患者和临床医生的担忧。多余的冷冻胚胎给体外受精患者和诊所带来了挑战；随着罗伊诉韦德案被推翻，一些州可能会认为丢弃多余胚胎是非法的，从而彻底改变体外受精的做法。基于证据的工具将有助于限制多余胚胎的产生。开发一种预测工具，用于确定应将多少卵母细胞暴露于精子来产生胚胎，以保留活产机会，同时最大限度地减少多余胚胎。这项诊断研究使用了辅助生殖技术协会临床结果报告系统成员诊所2014年至2019年的数据。从2014年1月1日至12月31日期间开始第一个卵母细胞刺激周期的311~237名18至45岁患者中，总共进行了410~719个卵母细胞取出和460~577个胚胎移植周期。 2019年，被纳入其中。对2022年2月至6月的数据进行了分析。最终模型中包括女性患者年龄、抗苗勒管激素水平、卵巢储备功能减退的诊断、取出的卵母细胞数量以及诊所所在的州。该算法基于 3 个模型，结果如下：(1) 转移日期； (2) 取出的卵母细胞成为可用囊胚的比例； (3) 发生 1 例活产时移植所需的囊胚数量。刺激周期开始时的中位年龄 (IQR) 为 35 (29-32) 岁，取出卵母细胞的中位 (IQR) 数量为 10 (6-17)。建议所有卵母细胞接触精子的可能性随着年龄的增长而增加；在 32 岁以下的患者中，只有不到 20.0% 的取卵者和在 42 岁以上的患者中，超过 99.0% 的取卵者收到了将所有卵母细胞暴露于精子的建议。在建议暴露少于所有卵母细胞的周期中，对于年龄小于 32 岁的患者，建议 1 次活产的中位 (IQR) 数量为 7 个卵母细胞 (7-8)，对于 32 至 34 岁的患者，建议为 8 (7-8) 个卵母细胞，对于 35 至 37 岁的患者，建议为 9 (9-11) 个卵母细胞。在这项体外受精周期的诊断研究中，开发了一种预测工具，以帮助临床医生确定暴露于精子的最佳卵母细胞数量，减少产生的未使用胚胎的数量，并立即解决当前患者和临床医生的担忧。
This diagnostic study estimates the optimal number of oocytes to attempt to fertilize during assisted reproductive technology treatment. How many oocytes should be exposed to sperm during an assisted reproductive technology cycle to minimize the number of unused embryos while optimizing the probability of a live birth? In this national registry–based diagnostic study, in 66.2% of cycles among patients younger than 38 years, fewer than all retrieved oocytes could be exposed to sperm to minimize the number of unused embryos while optimizing the probability of a live birth. These findings suggest the developed prediction tool could reduce the number of unused embryos created and immediately address current patient and clinician concerns. Surplus cryopreserved embryos pose a challenge for in vitro fertilization patients and clinics; with Roe v. Wade overturned, some states may deem the discarding of surplus embryos illegal, radically changing in vitro fertilization practice. An evidence-based tool would help limit surplus embryo creation. To develop a prediction tool for determining how many oocytes should be exposed to sperm to create embryos to conserve the chance of live birth while minimizing surplus embryos. This diagnostic study used data from member clinics of the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System between 2014 to 2019. A total of 410 719 oocyte retrievals and 460 577 embryo transfer cycles from 311 237 patients aged 18 to 45 years old who initiated their first oocyte stimulation cycle between January 1, 2014, and December 31, 2019, were included. Data were analyzed from February to June 2022. Female patient age, anti-mullerian hormone level, diminished ovarian reserve diagnosis, number of oocytes retrieved, and the state where the clinic is located were included in the final models. The algorithm was based on 3 models with outcomes: (1) day of transfer; (2) proportion of retrieved oocytes that become usable blastocysts; and (3) number of blastocysts needed for transfer for 1 live birth to occur. The median (IQR) age at stimulation cycle start was 35 (29-32) years and the median (IQR) number of oocytes retrieved was 10 (6-17). The likelihood of recommending that all oocytes be exposed to sperm increased with age; less than 20.0% of retrievals among patients younger than 32 years and more than 99.0% of retrievals among patients older than 42 years received recommendations that all oocytes be exposed to sperm. Among cycles recommended to expose fewer than all oocytes, the median (IQR) numbers recommended for 1 live birth were 7 oocytes (7-8) for patients aged less than 32 years, 8 (7-8) for patients aged 32 to 34 years, and 9 (9-11) for patients aged 35 to 37 years. In this diagnostic study of in vitro fertilization cycles, a prediction tool was developed to aid clinicians in determining the optimal number of oocytes to expose to sperm, reducing the number of unused embryos created and immediately addressing current patient and clinician concerns.
登录
查看更多内容
影响因子：
1.3
作者：
Hong, Yeon Hee;Kim, Hye Kyeong;Kim, Seok Hyun
通讯作者：
Kim, Seok Hyun
影响因子：
6.7
作者：
Klipstein, Sigal;Azziz, Ricardo;Zweifel, Julianne
通讯作者：
Zweifel, Julianne
影响因子：
6.7
作者：
Nachtigall, Robert D.;Mac Dougall, Kirstin;Becker, Gay
通讯作者：
Becker, Gay
DOI：
10.1016/j.xfre.2020.05.010
发表时间：
2020-09
期刊：
F&S reports
影响因子：
--
作者：
Christianson MS;Stern JE;Sun F;Zhang H;Styer AK;Vitek W;Polotsky AJ
通讯作者：
Polotsky AJ
影响因子：
6.7
作者：
Deniz, Stacy G.;Hughes, Edward G.;Karnis, Megan F.
通讯作者：
Karnis, Megan F.