未经促排卵的未成熟卵母细胞行体外成熟治疗不孕症的临床研究

In vitro maturation and fertilization of unstimulated immature oocyte for the treatment of infertile women

目的探讨未经任何药物刺激的未成熟卵母细胞行体外成熟（IVM）治疗不孕症的临床价值。方法40例不孕患者接受54个IVM周期，其中多囊卵巢综合征（PCOS）不孕患者26例，经其他辅助生育技术失败14例。在未采用任何药物刺激的前提下，于月经周期的第9—12天，在超声引导下经阴道对两侧卵巢内直径≤10mm的卵泡进行穿刺取卵。对取出卵母细胞于体外培养24～48h，待第一极体出现后，进行卵母细胞质内单精于注射（ICSI），18h后观察受精情况，继续培养24—48h，直至胚胎移植，移植前行激光辅助胚胎孵化。结果54个IVM周期中，有7个周期取消，取消率为13％；共移植周期47个，共获得未成熟卵母细胞857个，平均每周期18．2个。体外培养48h后，卵母细胞成熟率为73．7％（632／857），正常受精率为75．3％（476／632），卵裂率为91．2％（434／476）。移植日子宫内膜厚度平均为8．9mm，平均移植胚胎4．3个（2—6个）；1例生化妊娠，19例临床妊娠，每取卵周期的临床妊娠率为35％（19／54），每移植周期的临床妊娠率为40％（19／47）。26例PCOS不孕患者共移植周期34个，1例生化妊娠，15例临床妊娠，每移植周期的临床妊娠率为44％（15／34）。结论未经促排卵药物刺激的卵母细胞行IVM用于治疗各种原因的不孕症，尤其是PCOS不孕患者，是一种有效的治疗方法。

Objective To evaluate the efficacy of in vitro maturation （IVM） and fertilization of unstimulated immature oocytes for the treatment of infertile women. Methods Fifty-four cycles of IVM were carried out in 40 patients including 26 women with infertility due to polycystic ovary syndrome （PCOS）, and 14 patients with history of assisted reproductive technology （ART） failure. Transvaginal ultrasound-guided oocyte collection was performed during menstrual cycle days 9 - 12 without pretreatment of gonadotropins. After 24 - 48 hours of culture, the metaphase U stage oocytes were inseminated by intracytoplasmic sperm injection （ICSI）. Embryo transfer was performed 2 or 3 days after ICSL Laser assisted hatching was done before embryo transfer. Results Seven cycles were cancelled and the cancel rate was 13% （7/54）. A total of 857 immature oocytes were obtained with the mean numbers of 18. 2 per cycle, and 632 oocytes developed at MII stage （73.7%, 632/857）. A total of 476 oocytes were fertilized by ICSI （75.3%, 476/632）, with a cleavage rate of 91.2% （434/476）. Embryo transfer was performed in 47 cycles and the mean number of embryos transferred were 4. 3 per cycle （ range ： 2 - 6 ）. The mean endometrial thickness on the day of embryo transfer was 8.9 mm. Nineteen clinical pregnancies were obtained, giving a pregnancy rate of 35% （19/54） per start cycle and 40% （19/47） per transfer cycle. Conclusions IVM of unstimulated immature oocytes for the treatment of women with various causes of infertility especially due to PCOS is an effective alternative method. The clinical pregnancy rate of 40% （ 19/47 ） is similar to that by conventional in vitro fertilization treatment in our unit.