自然周期IVF/IVM、IVM和常规促排卵技术在不孕症治疗中的临床应用比较

Comparison of clinical outcomes for infertility treatment with natural cycle IVF/IVM,IVM and controlled ovarian hyperstimulation

目的探讨自然周期IVF结合未成熟卵母细胞IVM(自然周期IVF/IVM)和IVM技术与控制性促排卵技术(COH)相比,在不孕症治疗中的临床价值。方法根据筛查标准,将患者治疗方案分为以下3种类型:(A)自然周期IVF/IVM;(B)IVM;(C)COH。结果在1686个移植周期中,31.3%的周期(528个)应用自然周期IVF/IVM技术,12.8%实施IVM技术,55.9%通过COH方案治疗。自然周期IVF/IVM、IVM和COH的临床妊娠率分别为33.9%、39.8%和31.1%,IVM组高于其他两组但各组之间无显著差异,胚胎着床率也无显著差异。而IVM组的流产率(36.0%)高于其他两组(31.3%和25.9%),无显著统计学差异。结论从本研究可以看出,自然周期IVF/IVM和IVM方案可以解决近一半周期的不孕症患者,并且可以获得与COH相近的临床妊娠率。

Objective： To determine the clinical outcomes of natural cycle in vitro fertilization （IVF） combined with in vitro maturation （IVM） treatment （natural cycle IVF/IVM） , IVM alone compared with traditional controlled ovarian hyperstimulation （COH） on infertility treatment. Methods： Women with infertility according to ovarian reserve and endocrine profile were selected for different treatments. According to screening criteria, infertile women were divided into three treatments： （A） natural cycle IVF combined with IVM （IVF/IVM） ; （B） IVM alone; and （C） COH with gonadotropin. Results： A total of 1762 cycles were started, and 1686 cycles （95. 7%） were completed. Of 1686 cycles, 528 （31.3%） were treated by natural cycle IVFflVM, 216 （12. 8%） were conducted for IVM alone, and 942 （55.9%） underwent COH. The rates for IVM, fertilization and cleavage as well as clinical pregnancy and implantation were compared. Clinical pregnancy rates were 33.9% （179/528） for natural cycle IVF/IVM, 39.8% （86/216） for IVM alone, and 31.1% （293/942） for COIl with no significant differences among three groups as well as for implantation rate. Conclusion： Natural cycle IVF/IVM together with IVM-alone treatment can offer about half （44. 1%） of infertile women with an acceptable pregnancy and implantations rates.