試管嬰兒以冷凍胚胎取代新鮮週期植入:為此最好的的時代做好準備了嗎?

 

出處:第二名的不孕症期刊

 

Hum Reprod. 20131 (搶鮮版)

20131月,281:6-9

試管嬰兒以冷凍胚胎取代新鮮週期植入:為此最好的的時代做好準備了嗎?

 

英國的研究

 

傳統上,大多數在試管嬰兒(IVF)治療週期新鮮胚胎植入中的保留多餘的胚胎冷凍備用。隨著時間的推移冷凍保存設施的改善,鼓勵更多地使用這項技術(胚胎冷凍)成功率週期接近與新鮮胚胎移植的成功率。來自觀察性研究的數據表明,胚胎冷凍在產科和圍產兒結局是優於新鮮胚胎植入。在促進胎兒孕產婦安全的利益,因此它的時間,以避免新鮮胚胎移植試管嬰兒,凍結所有可用的胚胎,並取代他們在隨後的週期?在這篇文章中,我們探討這個概念的生物合理性,評價的證據基礎,並考慮採取這樣的策略,在常規臨床實踐的影響。現有的隨機試驗的結果出現有利於冷凍胚胎移植的策略,但可以考慮在臨床實踐中的重大變化之前,需要更大規模的試驗。

 

醫師的意見在優質的試管嬰兒中心普遍感受到冷凍胚胎植入懷孕率優於新鮮胚胎植入。這來自玻璃化(超快速)冷凍胚胎優於傳統的慢速冷凍胚胎植入。最重要的是產科結果是好的,有些學者或生殖中心鼓勵冷凍胚胎植入取代新鮮胚胎植入。我個人的臨床經驗亦覺得玻璃化(超快速)冷凍胚胎的懷孕率確實優良。但全球的生殖界及病患的觀念為此最好的時代做好準備了嗎?

 

 

Hum Reprod. 2013 Jan;28(1):6-9. doi: 10.1093/humrep/des386. Epub 2012 Nov 11.

Elective frozen replacement cycles for all: ready for prime time?

Maheshwari ABhattacharya S.

Source

Reproductive Medicine, Division of Applied Health Sciences, University of Aberdeen , Aberdeen Maternity Hospital , Aberdeen AB25 2ZL , UK .

Abstract

Conventionally, most in vitro fertilization (IVF) embryos are transferred in fresh treatment cycles with freezing reserved for spare ones. Improvement in cryopreservation facilities over time has encouraged the greater use of this technology with the success rate of frozen replacement cycles approaching that associated with fresh embryo transfer. Data from observational studies suggest that obstetric and perinatal outcomes are better in pregnancies resulting from frozen replacement cycles. In the interests of promoting feto-maternal safety is it therefore time to avoid fresh embryo transfers in IVF, freeze all available embryos and replace them in subsequent cycles? In this article we explore the biological plausibility of this concept, appraise the evidence underpinning it and consider the implications of adopting such a strategy in routine clinical practice. The outcomes of existing randomized trials appear to favour a strategy of frozen embryo transfer, but larger trials are needed before a major change in clinical practice can be considered.

 



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