Cryopreservation in human assisted reproduction is now routine for embryos but remains a research procedure for oocytes

Abstract

Human embryo cryopreservation represents an indispensable extension of in-vitro fertilization (IVF) programmes as long as they are based upon the recovery of a large number of oocytes. The most widely used procedures include the cryopreservation of human zygotes or embryos in early cleavage, using 1,2-propanediol and sucrose as cryoprotectants. Our results over a 10 year period (1986-1995) on 5032 thawed cycles involving 14 222 stored embryos make it possible to appraise the results and the contribution of embryo freezing to assisted reproduction. Embryos survived the freeze-thaw process in 73% of cases leading to 4590 transfers of 2.2 embryos (91% of thawed cycles). The clinical pregnancy rate per transfer was 16%, the live birth rate 12%, and the rate of babies born alive per transferred embryo was 6%. Embryo freezing monitored 10 years later produced an average of 8% of additional births. By then, 86% of stored embryos had been thawed for transfer to patients. Destruction or donation were required for only 8% of all frozen embryos and there was no news from the parental couple in relation to almost 6% of embryos. The fate of the vast majority of embryos was decided during the first 5 years of storage. Blastocyst cryopreservation is making new strides, thanks to co-culture systems and embryo selection. Micromanipulation procedures seem to have little impact on the outcome of embryo freezing. Human oocyte freezing is again clinically applied. Indeed, much of the concern about injuries to the oocyte structures through the freeze-thaw process do not seem to be justified, and the problems with frozen-thawed oocyte fertilization has been overcome using intracytoplasmic sperm injection (ICSI). As long as oocyte in-vitro maturation is not well controlled, better results will probably be obtained with mature oocyte cryopreservation. Emerging methods include the freezing of immature oocytes, follicles and ovarian tissue.

Correlation between embryological factors and pregnancy rate: development of an embryo score in a cryopreservation programme

“…As shown in numerous studies, no correlation has been established between implantation rate and the fertilisation technique employed [17,23,24]. In the latter study, significant differences were however established in terms of the rate of children born favouring the conventional IVF method.…”

“…Certain authors propose D + 2 of development as the optimum day for embryo cryopreservation and obtain a significantly higher pregnancy rates in this group of embryos compared to the ones that are cryopreserved on D + 3 [13,24]. Other authors have described significantly higher pregnancy rates in embryos cryopreserved on D + 3 compared to D + 2 [25,26].…”

Human oocyte and ovarian tissue cryopreservation and its application

“…At this stage the oocyte do not present a chilling-sensitive microtubular or meiotic spindle. Several other reports, however, paradoxically showed that the immature oocytes are more sensitive to freezing than mature oocytes [55,56,62], probably due to lower cell membrane stability and a particular cytoskeletal formation [56]. This sensitivity to cryopreservation also seems to be due to the damage or interruption of cumulus cell projections, which may control the intercellular communication between cumulus cells and oocytes during maturation [63].…”

“…The cryotop technique has been also modified by using a hermetically sealed container for storage to eliminate potential dangers of disease transmission [80]. A major breakthrough occurred when human pregnancies and deliveries from vitrified mature oocytes were obtained [62,81].…”

Tick Tock Goes the Clock: Rethinking Policy and Embryo Storage Limits

“…Today, three decades on, while the length of storage limits do vary between international jurisdictions (Bankowski et al 2005) the 10 year limit is still afforded substantial medical and scientific approval (Michelmann and Nayudu 2006;Mandelbaum et al 2011). In Australia, the 10 year limit remains the norm across most jurisdictions (Millbank et al 2013, 99).…”