卵巢高反应临床结局及其卵母细胞超微结构分析

The analysis of the clinical outcome and ultrastructure of the oocytes with ovarian high response

目的探讨控制性超促排卵周期中卵巢高反应对卵母细胞、胚胎质量及妊娠结局的影响。方法回顾性分析因输卵管因素和（或）男方因素初次行体外受精-胚胎移植/卵胞浆单精子注射（IVF-ET/ICSI）周期治疗的326例不孕患者的临床资料。根据人绒毛膜促性腺激素（HCG）日血清雌二醇（E2）水平、获卵数不同分为卵巢高反应组（HCG日血清E2〉3 000 pg/ml或获卵数〉15个,n=146）和正常反应组（HCG日血清E2500～3 000 pg/ml或获卵数5～15个,n=180）,分析两组间的MII卵率、受精率、卵裂率、优质胚胎率、种植率、临床妊娠率和流产率。并通过透射电子显微镜下观察两组卵母细胞透明带、卵母细胞卵周隙、卵母细胞细胞器等超微结构的变化。结果卵巢高反应组获卵数、优质胚胎数和移植周期取消率均显著高于正常反应组（P〈0.05）,MII卵率、受精率、优质胚胎率、可利用胚胎率、种植率和临床妊娠率均显著低于正常反应组（P〈0.05）。两组间卵裂率、流产率和中重度卵巢过度刺激综合征（OHSS）发生率差异均无统计学意义（P〉0.05）。高反应组的超微结构分析显示,部分卵母细胞胞质中出现大量异常线粒体。结论卵巢高反应影响卵母细胞质量及胚胎发育潜能,最终降低临床结局。

Objective To investigate the effects of high ovarian response on ooeyte quality, embryo quality and pregnancy outcome in controlled ovarian hyperstimulation cycles. Methods A retrospective study was designed covering 326 infertile patients with male and （or） tubal factor who were admitted first in vitro fertilization and em- bryo transfer/intracytoplasmic sperm injection （IVF-ET/ICSI） treatment from January 2011 to December 2012. The oocyte and embryo parameters and pregnancy outcome were compared between high responder group （peak E2 〉 3 000 pg/ml on the day of HCG administration or the number of oocytes retrieved 〉 15, n = 146） and normal re- sponder group （500 pg/ml ≤ peak E2 ≤3 000 pg/ml on the day of HCG administration or 5 ≤ the number of oo- cytes retrieved ≤ 15, n = 180）. The uhrastructures of oocytes between two groups were observed using transmission electron microscope, including zona pellucida, perivitelline space, oocyte organelles. Results The numbers of oo- cytes, good-quality embryos, the cycle cancellation rate in high responder group were significantly higher than those of normal responder group （P 〈 0.05 ） , but the MII oocytes rate, fertilization rate, high-grade embryo rate, im- plantation rate and clinical pregnancy rate were significantly lower than those of normal responder group （P 〈 0.05 ）. There were no statistical differences in cleavage rate, miscarriage rates, the incidence of moderate and se- vere ovarian hyperstimulation between two groups （P 〉 0. 05 ）. The ultrastructure showed that abnormal mitochon- dria increased significantly in the high responder group. Conclusion The high ovarian response can affect the oo- cytes quality and embryo development potentiality, ultimately reduce the pregnancy outcome.