体外受精周期中卵泡发育阻滞患者应用未成熟卵体外成熟培养的临床观察

Clinical study on the application of in vitro maturation treatment in the patients with follicle development retardation in in vitro fertilization cycles

目的观察常规体外受精(IVF)中卵泡发育阻滞患者采用未成熟卵体外成熟(IVM)培养治疗结果。方法常规IVF治疗患者11例,在促排卵过程发生卵泡发育阻滞时,取卵行IVM培养成熟后,卵母细胞行卵胞浆内单精子注射(ICSI)以获得受精卵并最终实现胚胎移植。统计分析未成熟卵的成熟率、卵母细胞的受精率、胚胎的发育情况及临床结果。结果共获取卵母细胞128枚,其中成熟卵21枚,行ICSI后15枚正常受精,获10枚正常卵裂胚胎,全部移植3例,均未妊娠;107枚未成熟卵,经IVM、ICSI和体外培养后,成熟率、受精率、正常卵裂率及优质胚胎率分别为72.9%、75.6%、78%及39.1%,胚胎移植后3例临床妊娠(新鲜周期2例,冻融周期1例)。结论常规IVF控制性超促排卵(COH)过程中,发育阻滞的卵泡在体外适宜的培养条件下仍有成熟、受精、继续发育的能力,并最终实现临床妊娠。IVM技术是改善IVF中发生卵泡发育阻滞患者结局的措施之一。

Objective： To analyze of the effect of IVM treatment undertaken to the patients with follicle developmental retardation during the process of conventional induced ovulation on the outcome of IVF cycles. Methods： One hundred and seven immature oocytes were retrieved from the ovaries of 11 patients with follicle developmental retardation and matured in vitro. The in-vitro matured oocytes were fertilized by ICSI and transferred to the patients. The mature rate of immature oocytes, fertilization rate of matured oocytes, embryo development and the clinical outcomes were analyzed. Results： The overall maturation rate, fertilization rate, cleavage rate and good embryo rate were 72.9% （78/107）, 75.6% （59/78）, 78% （46/59） and 39.1% （18/46）, respectively. Two clinical pregnancies were achieved in fresh cycles and one in frozen-thawed cycles. Conclusions： The results form these cases indicate that these immature oocytes could be matured and fertilized in vitro, and then transferred to grow normally to term in uteri. It is appropriate to modify the current application of IVM treatment for not only PCOS and PCO-like patients, but also the people with follicle developmental retardation in conventional IVF cycles.