体外受精周期中不同改行时机对未成熟卵体外培养结局的影响

The clinical effect of in vitro maturation transferred from conventional in vitro fertilization cycles at different time

目的:探讨常规体外受精周期中,不同改行时机对未成熟卵体外培养结局的影响。方法:回顾性分析2008年1月至2009年12月,在温州医学院附属第一医院生殖医学中心行常规体外受精(in vitrofertilization,IVF)过程中为预防出现卵巢过度刺激综合征或因卵泡发育迟缓,改行未成熟卵体外培养(in vitro maturation,IVM)的91例患者,按促性腺激素(gonadotropin,Gn)使用天数不同分为两组,A组使用Gn 5～7 d,共51例,B组使用Gn 8～13 d,共40例。比较两组的一般指标、Gn用量、体外成熟与胚胎发育及妊娠结局。结果:两组年龄、不孕年限、基础激素水平均差异无统计学意义(P>0.05)。Gn使用量A组明显低于B组,但获卵数A组明显高于B组,差异均有统计学意义(P<0.05)。取卵日的雌激素以及黄体生成素水平A组明显高于B组,而孕激素水平则B组高于A组,差异均有统计学意义(P<0.05)。两组的卵子成熟率、受精率、卵裂率、优胚率、种植率差异均无统计学意义(P>0.05)。两组的移植周期率、hCG阳性率、周期取消率、临床妊娠率、多胎妊娠率、自然流产率、异位妊娠率等临床结局差异均无统计学意义(P>0.05)。结论:体外受精咛ヒ浦仓芷谥校煌被男蠭VM均能获得较好的临床结局,但Gn使用后5～7 d比8～13 d可以显著减少促排卵药物的用量,增加获卵数,降低治疗费用。

Objective： To investigate the clinical effect of in vitro maturation transferred from conventional in vitro fertilization cycles by different time.Methods： Ninety-one infertile women in our center accepted IVF treatment during the period from January 2008 to December 2009 were analyzed retrospectively.All of them were slow responders or have the tendency of ovarian hyperstimu-lation syndrome（OHSS）.They were divided into two groups based on the differ time of using gonadotropin（Gn）： Gn was used in group A for 5～7 days and in group B for 8～13 days.The general index,the dosage of gonadotropin,laboratory and the clinical outcome of the two groups were compared.Results： There were no statistically significant differences in age,time of infertility and basal hormones level（P 0.05）.The dosage of Gn in group A was obviously lower than that in group B.The number of oocyte retrieved in group A was obviously higher than that in group B.There was also no statistically difference in the rates of fertilization,cleavage,and clinical pregnancy between the two groups（P 0.05）.Conclusion： The program of different time IVM converted from C-IVF obtains a satisfactory outcome,but use Gn 5～7 days can get more oocytes and significantly reduce the Gn dosage than that use Gn 8-13 days.