超排卵周期未成熟卵体外培养的研究

Study on in vitro Maturation of Immature oocytes Derived from Controlled Ovarian Hyperstimulation Cycles

目的:研究来源于超排卵周期中的未成熟卵在拆除卵丘细胞后进行体外成熟培养(IVM)的成熟、受精及胚胎发育能力,探讨IVM技术的临床应用。方法:选取46名体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)患者为研究对象,比较MI和GV期不成熟卵的体外成熟情况,并比较体内成熟卵和体外成熟卵进行ICSI后的正常受精、异常受精、卵裂和优质胚胎形成情况。结果:体外培养中69.8%的MI期卵和77.2%的GV期卵均在24小时内达到成熟,其24小时和48小时的成熟率、总成熟率均无明显差异(P>0.05)。体外成熟卵与体内成熟卵相比较,正常受精率、异常受精率和卵裂率均无明显差异(P>0.05),优质胚胎形成率较低,差异有显著性(P<0.05)。结论:常规超排卵周期中的未成熟卵在拆除卵丘细胞后能够继续体外发育成熟,具有与体内成熟卵相似的ICSI受精、卵裂能力。虽然优质胚胎的形成率低于体内成熟卵,但增加了可移植胚胎和冷冻胚胎数量,提高了助孕成功率。

Objective: To investigate the maturation, fertilization and developmental competence of cumulus-free immature human oocytes derived from controlled ovarian hyperstimulation(COH) cycles by in vitro maturation (IVM) culture, and to approach the clinical use of IVM. Methods: 46 IVF/ICSI-ET patients were enrolled in the study. The maturation rate of MI and GV oocytes, normal fertilization rate, abnormal fertilization rate, cleavage rate and top quality embryo formation rate between oocytes matured in vivo and in vitro were compared. Results: 69.8% MI oocytes and 77.2 GV oocytes reached to MII within 24h IVM. There was no difference in maturation rate of 24h and 48h, and total maturation rate between MI and GV oocytes(P>0.05). The normal fertilization rate, abnormal fertilization rate, cleavage rate between oocytes maturated in vivo and in vitro had no difference(P>0.05), but top quality embryo formation rate derived from immature oocytes was significantly lower when compared with oocytes matured in vivo(P<0.05). Conclusions: The cumulus-free immature human oocytesderived from COH cycles could mature in vitro and had similar competence of fertilization and cleavage as oocytes matured in vivo. Although top quality embryo formation rate was lower than oocytes matured in vivo, IVM of immature oocytes increased the number of embryos for ET and cryopreservation, decreased the cancellation cycle thus improved the results of ART.