年龄及卵巢刺激对卵子利用率的影响

The influence of age and ovarian stimulation on oocyte utilization

目的：探讨不同年龄及卵巢刺激对周期活产率、每卵活产率和每活产所需的卵子数的影响。方法：回顾性分析2012年1月-2014年2月在我院生殖医学中心行卵胞浆内单精子注射（ICSI）的1637个有移植周期的临床资料，按不同年龄或获成熟卵子个数不同分组，比较各组患者周期活产率、每卵活产率和每活产所需的卵子数，分析临床结局。结果：每个活产所需成熟卵子数以及每个成熟卵子的活产率显示卵子质量在23—37岁间相对稳定，37岁之后每卵活产率开始逐步下降，40岁之后显著下降，实现活产所需的卵子数目增加明显。卵巢反应性不同的3组比较发现，获成熟卵子数目多的组，周期累积活产率高，提示周期累积活产率可能与成熟卵子数量有关；每卵活产率与卵巢反应性呈负相关，成熟卵子数越多，每卵活产率越低（P〈0．01），每活产所需的卵子数越多（P〈0．01），提示过度卵巢刺激可能影响卵子质量。结论：估算实现不同年龄女性活产所需的卵母细胞数量对于妊娠结局的预测以及患者咨询的解答具有一定的指导意义，并可以为希望通过卵子冷冻进行生育力保存的妇女及本中心开展卵子冷冻项目提供参考数据。

Objective： To explore the effect of live birth per cycle, number of live births per mature oocyte and the number of mature oocytes per live birth according to ovarian ageing and ovarian response. Methods： A total of 1637 ICSI-ET cycles from January 2012 to February 2014 in Reproductive Medicine Center of the First Affiliated Hospital of Wenzhou Medical College were retrospectively analyzed. Live birth per cycle, number of live births per mature oocyte and number of mature oocytes per live birth were further analysed in relation to the age or ovarian response. The clinical outcomes were compared. Results： The data presented in this study showed that the number of live births per mature oocyte and the number of oocytes per live birth remained remarkably stable between the age of 23 and 37 years. After the age of 37 years number of live births per mature oocyte be- gan to decrease gradually but from 40 years of age it dropped dramatically, and the number of mature oocytes per live birth increased. On the other hand, the pregnancy rate per cycle increased with the number of retrieved oocytes, so the pregnancy rate per cycle was highly dependent on ovarian response. Compared between the three ovarian response group, number of live births per mature oocyte was lower （P〈0.01） and the the number of oo- cytes per live birth was higher （P〈0.01） in the response group with more mature oocytes, which indicated that the ovarian stimulation might affect the reproductive potential of the individual oocyte. Conclusion： These data are extremely valuable as they provide information on the expected outcome in women undergoing fertility preserva- tion. Moreover, it is crucial in the prediction of IVF success and patient counseling and considering the launching oocvte freezing for fertility preservation in our center.