辅助生殖技术中取卵失败的研究

Failed Oocyte Retrieval in Assisted Reproductive Technology

目的:探讨辅助生殖技术中取卵失败(failed oocyte retrieval,FOR)的发病率、原因及预后。方法:从同济医院生殖中心2000.01～2009.05期间所有病例中筛查出所有取卵失败周期,分析可能的原因,并通过后续周期获卵及妊娠情况,分析不同原因取卵失败患者的预后情况。结果:共有10 279个取卵周期,其中49个周期(0.48%)取卵失败。35个周期(71.4%)取卵失败与卵巢反应不良有关,4个周期为人绒毛膜促性腺激素(hCG)作用时间不足所致,5个周期与卵子发育障碍相关,其余5个周期原因不明。hCG因素的3个后续周期中,2例分别获卵9枚、8枚,1例临床妊娠;1例左侧卵巢取卵失败时停止取卵,24 h后穿刺右侧卵巢,共取到卵7枚,移植2个胚胎但未妊娠。原因不明的3个后续周期中2例分别获卵13枚、7枚,均临床妊娠;另1例左侧卵巢取卵失败时停止取卵,6 h后行第2次取卵仍未获卵。卵子发育障碍患者中1例继续行助孕治疗,共启动3个周期,平均取卵1.3±1.5枚,未妊娠。卵巢反应不良患者中5例继续行助孕治疗,共行6个后续周期,其中1例取卵32枚,因OHSS取消移植;另5个周期平均获卵3.2±2.6枚,1例临床妊娠。结论:取卵失败发病率低,本中心发病率仅0.48%(49/10 279)。卵巢反应不良、hCG作用时间不足及卵子发育障碍为常见原因。单纯由hCG因素导致的取卵失败预后良好,卵子发育障碍者预后欠佳,卵巢反应不良和不明原因的取卵失败预后决定于内在病因。

Objective： To investigate the incidence, relevant factors and the prognosis of failed oocyte retrieval （FOR）. Methods： All the FOR cycles from all the records were screened between 2000.01 and 2009.05. The relevant factors of FOR and the prognosis by the fertility performance such as number of oocytes retrieved and pregnancy results in subsequent cycles were analyzed. Results： Forty-nine （0.48%） FOR cycles were identified from 10 279 oocyte retrieval cycles in Tongji Hospital. Thirty-five （71.4%） FOR cycles were associated with poor ovarian response （POR）. Four cycles resulted from insufficient exposure to hCG and 5 were related to abnormal oogenesis. Th.e remaining 4 were still idiopathic. Two hCG-related FOR patients performed subsequent cycles. Nine and 8 oocytes were retrieved respectively and 1 patient achieved clinical pregnancy. One hCG-related patient interrupted the operation at the time of unsuccessful oocyte retrieval on the left ovary and rescheduled the retrieval 24 h later. Seven oocytes were recovered and 2 embryos were transferred but no pregnancy resulted. Two idiopathic patients performed subsequent cycles. Thirteen and 7 oocytes were recovered respectively and both achieved clinical pregnancy. One idiopathic FOR patient stop the oocyte retrieval when failed on the left ovary and rescheduled another operation 6 h later but still no oocytes were recovered. One patient of abnormal oogenesis performed 3 subsequent cycles and retrieved 1.3 ± 1.5 oocytes but no pregnancy resulted. Five POR patients performed 6 subsequent cycles and 1 had recurrence. One of them had 32 oocytes retrieved but the cycle was cancelled due to OHSS. The other 5 POR cycles only had 3.2 ± 2.6 oocytes and no pregnancy obtained. Conclusions： Unsuccessful oocyte retrieval due to pure hCG problem has good prognosis while the abnormal oogenesis tend to have poor prognosis. Prognosis of poor response and idiopathic FOR patients depends on the underlying etiology.