常规体外受精-胚胎移植周期中改行未成熟卵母细胞体外培养的临床研究

Clinical study on in vitro maturation of immature oocytes transferred from conventional in vitro fertilization

目的探讨常规体外受精-胚胎移植（IVF-ET）周期中改行未成熟卵母细胞体外培养（IVM）的临床疗效果。方法回顾性分析2008年1月至2009年6月在温州医学院附属第一医院生殖医学中心行常规IVF治疗，在促排卵5～7d后，双侧卵泡数目≥20个，或用药8～13d后，卵泡发育缓慢且两侧卵泡数F1≥15个，平均最大卵泡直径≤12mm的155个周期，根据患者意愿，即刻停药取卵、改行IVM治疗60个周期（A组），继续按照IVF常规治疗95个周期（B组）。比较两组促性腺激素（Gn）的用量、周期取消率、平均获卵数、受精率、优质胚胎率、移植周期数、卵巢过度刺激综合征（OHSS）的发生率及妊娠结局。结果周期移植率A组为92％（55／60），B组为63％（60／95），两组比较，差异有统计学意义（P〈0．05）。平均Gn用量、平均获卵数、卵裂率、OHSS发生率A组分别为（1030±468）U、（10±6）个、82．2％（231／281）、0，B组分别为（1544±338）U、（14±4）个、94．0％（502／534）、35％（21／60），曲组比较，差异均有统计学意义（P〈0．05）；两组的受精率和优质胚胎率比较，差异无统计学意义（P〉0．05）。A组29例临床妊娠，每移植周期的临床奸娠率为53％（29／55），多胎妊娠发生率为14％（4／29）；B组28例临床妊娠，每移植周期的临床妊娠率为47％（28／60），多胎妊娠发生率为32％（9／28）；两组比较，差异无统计学意义（P〉0．05）。结论常规IVF周期由改行IVM．不仅可以避免OHSS的发生和减少促排卵药物的使用．还可获得较高的临床妊娠率。

Objective To investigate clinical effect of in vitro maturation （IVM） of immature oocytes transferred from conventional in vitro fertilization embryo transfer （IVF-ET） cycles. Methods From January 2008 to June 2009, medical documents of 155 infertile patients underwent IVF-ET in the Reproductive Medical Center of First Affiliated Hospital of Wenzhou Medical College were analyzed retrospectively. If more than 20 oocytes were monitored after 5 - 7 days of ovulation induction or follicular developmental retardation were confirmed after 8 - 13 days of ovulation induction, according to patients＇ wish, IVM were transferred in 60 cycles （group A）. In the mean time, IVF was continued in 95 cycles （ group B）. The mean dosage of gonadotropin, the cancellation rate of cycles, the mean numbers of oocytes retrieved and maturation, the rate of fertilization and excellent quality embryos, pregnancy outcome and the incidence rate of ovarian hyperstimulation syndrome （OHSS） were compared and analyzed. Results The rates of embryo transfer were 92% （55/60）in group A and 63% （60/95） in group B, which showed significant differences （ P 〈 0. 05）. In group A, the mean dosage of the gonadotropin, the mean number of oocytes retrieved, the cleavage rate and OHSS rate were （1030 ± 468） U, 10 ±6. 82. 2% （231/281）and 0, and were （ 1544 ±338）U, 14 ±4, 94. 0% （502/534） and 35% （21/60） in group B, respectively, all data above exhibited statistical difference between two groups （P 〈 0. 05 ）. However, the rates of fertilization and excellent quality embryos had no significant differences between two groups（P 〉 0. 05）. In group A, the rate of clinical pregnancy per transfer was 53% （29/55） and multiple pregnancy was 14% （4/29）, and were 47% （28/60） and 32% （9/28） in group B, they all had no significant differences （P 〉 0. 05 ）.Conclusion IVM of immature oocytes used in conventional IVF cycles not only obtained a high clinical pregnancy rate, but also reduced gonadotropin using dosage and avoided OHSS completely.