超声检测取卵日卵泡大小在评价卵母细胞成熟度及其发育中的意义

Relationship of follicular diameter detected by transvaginal ultrasound with oocyte maturity and development

目的 探讨体外受精与胚胎移植（IVF-ET）中，取卵日卵泡直径与相应卵母细胞成熟度及受精、卵裂等的关系。方法 采用经阴道超声引导下单卵泡穿刺、单卵受精及单胚胎培养，回顾性分析接受IVF-ET治疗的30个周期中80个卵泡及其获得的卵母细胞，对取卵日卵泡直径与卵母细胞的卵冠丘复合物（OCCC）评分及受精、卵裂评分进行比较和分析。结果 按卵泡直径分组比较：A组为大卵泡组，卵泡直径≥16mm，共33个卵泡；B组为小卵泡组，卵泡直径〈16mm，共47个卵泡。A组与B组的卵泡液雌二醇分别为（621．78±229．29）ng／ml、（473．64±225．13）ng／ml，孕酮分别为（7020．97±1398．20）ng／ml、（5337．10±2261．78）ng／ml，OCCC评分分别为1．73±0．45、1．34±0．48，受精评分分别为3．06±0．75、1．70±1．40，卵裂评分分别为4．36±0．55、2．74±1．86，差异均有统计学意义（P〈0．01）。②卵泡直径与卵母细胞成熟度OCCC评分（r=0．33，P〈0.01）、受精评分（r=0．52，P〈0．01）、卵裂评分（r=0．51，P〈0．01）、雌二醇（r=0．29，P〈0．01）、孕酮（r=0．54，P〈0．01）呈正相关。③A组和B组卵泡中成熟卵母细胞分别为24和14个，各占其卵泡总数的72．7％、30．0％，差异有统计学意义（X^2=14．33，P〈0．01）。结论 取卵日经阴道超声检测卵泡直径的大小与卵母细胞成熟度、受精和卵裂有一定的关系。卵泡直径越大，卵母细胞成熟度、受精评分和卵裂评分均越高。

Objective To investigate the relationship between follicular diameter on the day of ovulation induction and oocyte maturity, the fertilization and cleavage grades of each oocyte. Methods Retrospective study of eighty follicles and its oocytes in single follicle retrieval. Oocytes were insemination and were cultivated individually and the grade of oocyte-corona-cumulus complexs （OCCCs） maturity, the scores fertilization and cleavage of each oocyte were recorded. Results According to different follicle diameters： group A was larger follicle group including follicles with a mean diameter ≥16 mm; group B was smaller follicle group including follicles with a mean diameter 〈 16 mm. In group A and B, the levels of estradiol in follicular fluid were （621.78 ± 229.29）ng/ml, （473.64 ± 225.13）ng/ml; the levels of progesterone were （7020.97 ± 1398.20） ng/ml, （ 5337.10 ± 2261.78 ） ng/ml; the grades of OCCCs were 1.73 ± 0.45,1.34 ±0.48; the grades of fertilization were 3.06 ± 0.75,1.70 ± 1.40; and the grades of cleavage were 4.36 ± 0. 55,2.74 ± 1.86. Among those, there were significant differences in the levels of estradiol,progesterone, the grades of oocyte maturity, fertilization and cleavage between group A and B （P 〈 0.01 ）. The follicle diameter was positively correlated with the oocyte maturity, the grades of fertilization and cleavage, the levels of estradiol, progesterone in follicular fluid （ r = 0. 33, P 〈0.01 ; r = 0.52, P〈0.01; r =0.51, P〈0.01; r =0.29, P〈0.01; r =0.54, P〈0.01）. The number of mature oocytes in group A and B were 24 and 14,those ratio were 72.7% and 30.0%. The mature oocytes ratio in group A was significantly higher than that in group B（X^2 = 14.33, P 〈0.01）. Conclusions There is some association between the diameter measured by ultrasound on the day of ovulation induction,oocyte maturity and fertilization and cleavage grades. It may be the bigger of diameter, the higher of oocyte maturity and fertilization and cleavage grades.