无刺激周期未成熟卵母细胞体外培养用于多囊卵巢综合征不孕患者治疗的临床观察

In vitro maturation and fertilization of oocytes from unstimulated cycles in women with infertility due to polycystic ovary syndrome

目的探讨无刺激周期未成熟卵母细胞体外培养在治疗多囊卵巢综合征(PCOS)不孕患者的应用价值。方法对70例PCOS患者,在人工周期或自然周期第10～12天行阴道B超监测,如双侧卵巢中无直径>8mm的卵泡,即肌内注射人绒毛膜促性腺激素10000IU,36h后经阴道穿刺取卵,将取出的未成熟卵母细胞进行体外成熟及体外受精胚胎移植。结果共进行体外成熟周期94个,移植周期75个。共获得卵母细胞1283个,获得成熟838个(65.3%,838/1283),其中受精553个(66.0%,553/838),获得胚胎402个(48.0%,402/838),获得优质胚胎199个(23.7%,199/838)。生发泡期卵母细胞的成熟率、受精率、获得胚胎率及优质胚胎率,分别为67.7%、66.4%、47.6%及24.1%;第1次减数分裂中期的卵母细胞,分别为69.7%、71.7%、52.2%及26.1%,生发泡期与第1次减数分裂中期比较,差异均无统计学意义(P>0.05)。无法评价的卵母细胞的成熟率、受精率、获得胚胎率及优质胚胎率,分别为44.8%、53.8%、46.2%及16.9%,与生发泡期及第1次减数分裂中期比较,差异均有统计学意义(P<0.05)。75个移植周期中,18例获得临床妊娠,妊娠率为24%(18/75)。结论无刺激周期未成熟卵母细胞体外成熟及体外受精胚胎移植可用于PCOS不孕患者的治疗,并能取得一定的妊娠成功率。

Objective To investigate the effect of in vitro maturation(IVM) and fertilization of oocytes from unstimulated cycles in women with infertility due to polycystic ovary syndrome(PCOS). Methods Seventy women with PCOS, who came to our clinic during March to were involved in this trial. June 2003. Every cycle was given human chorionic gonadotropin 10 000 IU 36 h before oocyte retrieval. Immature oocytes were matured in vitro and fertilized, and the resulting embryos were replaced back to the uterus. Results A total of 94 IVM cycles were performed and 1283 oocytes were obtained. The overall maturation, fertilization and cleavage rates were 65.3%, 66.0% and 48.0% respectively. Maturation, fertilization, cleavage and high quality embryo rates had no difference between metaphase I stage oocytes (69.7%, 71.7%, 52.2% and 26.1% respectively) and germinal vesical (GV) stage oocytes (67.7%, 66.4%, 47.6% and 24.1% respectively), but the rates in those oocytes which could not be classified (44.8%, 53.8%, 46.2% and 16.9% respectively) were much lower than the former two groups. After embryo transfer, 18 pregnancies were reported (24%). Conclusion IVM/IVF-ET in unstimulated cycles is a feasible treatment for women with PCOS.