卵巢早衰与卵子赠送22例分析

Premature ovarian failure and oocyte donation:a report of 22 cases

１９９２年１０月～１９９５年６月共进行卵巢早衰（ＰＯＦ）２２例３１周期卵子赠送。供者采用ＧｎＲＨ－ａ／ＨＭＧ／ｈＣＧ超排卵方案，受者采用外源性类固醇激素替代治疗（ＨＲＴ），周期第２１天行子宫内膜活检，选择子宫内膜分泌期病例采用受者丈夫精子于ＨＲＴ第１５～２０天进行体外授精和胚胎移植（ＩＶＦ－ＥＴ）。结果：临床妊娠率３６％（１１／３１），双胎妊娠４例，单胎任娠７例，１９９４年ｌ月１４日诞生国内首例ＰＯＦ卵子赠送新生儿，目前继续妊娠３例，流产６例。完整卵泡簇供卵组较ＩＶＦ－ＥＴ剩余卵子供卵组在移植胚胎数目、胚胎评分、移植后妊娠率显著提高，分别为Ｐ＜０．０５、＜０．００１及＜０．０５；而流产率显著降低，Ｐ＜０．００１；受卵者年龄＜３０岁组和＞３０组在移植胚胎数目和胚胎评分无显著差异（Ｐ均＞０．０５），而临床妊娠率分别为４２％和３２％，存在明显差异（Ｐ＜０．０５）。在ＨＲＴ第１６～１８天移植胚胎获得妊娠率较高（９／２２），大于ＨＲＴ第２０天或胚胎发育与子宫内膜发育相差超过±２天无妊娠病例。以上结果提示：ＨＲＴ和卵子赠送是ＰＯＦ患者获得妊娠的有效方法；卵子质量是影响胚胎发育、移植后妊娠率及自然流产率的重要因素；子宫内?

bjective:To review the result of oocyte donation in 3l cycles of 22 cases of premature ovarian fail-Methods:22 premature ovarian failure patients had received hormones replacement therapy and in vitro fertilization with their husbands,sperm and donors'oocyte.Induction of ovalation by GnRH-a/ HMG/hCG regimen was used in donors.Urine LH levels were rneasured by one-step accutest LH ovula- tion test.Results:Clinical pregnancy rate was36%.Comparison of the results showed a highly singificant in-crease in embryo qualit(P<0.05)and clinical pregnance rate(P<0.05)when the whole cohort of ova was used.The miscarr age rate was significantly decrease (P<0.00l).No difference was found in the scoring of embryo quality and the number of embryo transfered per cycle.However,the pregnancy rate in the younger group(42%)is singnificantly higher than that in the elder group (32%,P<0.0l);The re-ceptivity window of a 2-day embryo was from 15th to 19th day of a 28-day cycle,and the pregnancy rate is higher from day l6 to l8 in the 28 days cycle.Conclusion:The quality of ovum is an important factor to influence the embryo development,preg-nancy rate and misscarrage,Selecting the whole cohort ova can get higher pegnancy rate.The endometri-um recepitivety is also an important factor influencing pregnancy rate,Which declines with increase of age.