未成熟卵母细胞体外成熟技术在多囊卵巢综合征不孕症治疗中的应用

Clinical application of in vitro maturation of human immature oocytes for infertile women with polycystic ovary syndrome

目的 探讨未成熟卵母细胞体外成熟技术（IVM）在多囊卵巢综合征（PCOS）不孕症治疗中的价值.方法 2003年1月至2009年12月,安徽医科大学第一附属医院生殖医学中心采用IVM技术治疗PCOS不孕症患者157例,共162个周期（IVM组）；选取同期常规体外受精（IVF）或单精子卵细胞胞质内注射（ICSI）治疗PCOS不孕症患者109例,共114个周期（对照组1）,以及非PCOS不孕症患者106例,共106个周期（对照组2）作为对照.比较3组患者治疗、妊娠结局及新生儿情况.结果 IVM组、对照组1、对照组2患者尿hCG阳性率分别为35.7％（56/157）、42.2％（46/109）、44.3％（47/106）,妊娠率分别为29.3％（46/157）、37.6％（41/109）、41.5％（44/106）,异位妊娠率分别为1.9％（3/157）、1.8％（2/109）、0.9％（1/106）,流产率分别为18.6％（8/43）、12.8％（5/39）、20.9％（9/43）,活产率分别为22.3％（35/157）、31.2％（34/109）、32.1％（34/106）,各指标IVM组分别与对照组1、2比较,差异均无统计学意义（P＞0.05）；3组新生儿中,早产率、低出生体质量儿率、新生儿体质量、男女性别比例分别比较,差异均无统计学意义（P＞0.05）；IVM组中位促排卵天数6d、中位促性腺激素用量675 IU、治疗总费用（8392±1328）元,均少于对照组1、2,差异均有统计学意义（P均＜0.01）；IVM组多胎率4.7％（2/43）和卵巢过度刺激综合征（OHSS）发生率（0）均低于对照组1、2,差异均有统计学意义（P均＜0.01）.结论 IVM适用于PCOS不孕症患者,能获得与常规IVF或ICSI相似的妊娠结局,并能减少治疗费用、降低多胎妊娠和OHSS发生率.

Objective To investigate clinical effect and safety of in vitro maturation（IVM）of human immature oocytes in infertile women with polycystic ovary syndrome by comparing with conventional in vitro fertilization（IVF）and intracytoplasmic sperm injection（ICSI）.Methods From Jan.2003 to Dec.2009,157 infertile women with PCOS underwent 162 cycles IVM in Center for Reproductive Medicine,the First Affiliated Hospital of Anhui Medical University.In the mean time,109 patients with PCOS underwent 114 IVF/ICSI cycles as control group 1 and 106 patients with other factors underwent 106 IVF/ICSI cycles as control group 2.Treatment and outcome of pregnancy and infant were compared among those 3 groups.Results No statistically significant difference were found in terms of the positive rate of hCG in urine[35.7%（56/157）,42.2%（46/109）,44.3%（47/106）],the rate of clinical pregnancy[29.3% （46/157）,37.6%（41/109）,41.5%（44/106）],the rate of entopic pregnancy[1.9%（3/157）,1.8% （2/109）,0.9%（1/106）],the rate of miscarriage[18.6%（8/43）,12.8%（5/39）,20.9%（9/43）]and the rate of live-birth[22.3%（35/157）,31.2%（34/109）,32.1%（34/106）]among three grbups（IVM group,control group 1,control group 2,P 〉 0.05）.The rate of preterm labor,low weight newborn,mean birth weight,ratio of male to female did not show significantly difference among 3 groups（P 〉 0.05）.The average control ovarian stimulation was 6 days,the median dose of gonadotropin（Gn）was 675 IU,and the total hospital cost was（8392 ± 1328）RMB in IVM group,which were statistically lower than those in the other two control groups（P 〈 0.01）.The rate of multiple pregnancy was 4.7%（2/43）and ovarian hyperstimulation syndrome（OHSS）0 in IVM group,which were significantly lower than those in the other control group（P 〈0.01）.Conclusion In vitro maturation is an effective treatment in infertile women with PCOS,it could obtain the similar pregnancy outcome and reduce total cost,the dosage of gonadotropinreleasing hormone and rate of OHSS compared with conventional IVF/ICSI.