褪黑素用于胚胎培养对卵巢储备功能低下患者体外受精-胚胎移植治疗效果的影响

Effect of melatonin on in vitro fertilization embryo transfer treatment in patients with decreasing ovarian reserve

目的探究褪黑素(MT)应用于胚胎体外培养能否改善卵巢储备功能低下(DOR)患者体外受精-胚胎移植(IVF-ET)治疗效果。方法收集进行辅助生殖治疗的DOR患者共128例,所有患者均采用拮抗剂方案促排卵,根据是否在胚胎培养液中添加MT(MT浓度为10^(-9)mol/L),将患者分成褪黑素组(n=56)和对照组(n=72)。结果两组患者后期胚胎培养过程中卵子受精率、卵裂率差异均无统计学意义,但褪黑素组的囊胚形成率(65.22%vs 56.16%)及优质囊胚率(52.96%vs 40.94%)均较对照组高,且差异均有统计学意义(P<0.05)。两组患者冻胚移植的种植率(50.00%vs 38.67%)和临床妊娠率(48.39%vs 46.00%)相比较差异均无统计学意义,但褪黑素组获得优质囊胚的周期占比数较对照组高(85.71%vs 69.44%),且差异有统计学意义(P<0.05)。结论MT应用于早期胚胎的体外培养在一定程度上能促进卵巢储备功能低下患者卵子的发育,提高胚胎质量,最终可以实质性地改善此类患者的治疗效果。

Objective To investigate whether the application of melatonin(MT)in embryo culture in vitro can improve the treatment effect of in vitro fertilization embryo transfer(IVF-ET)in patients with decreasing ovarian reserve(DOR).Methods 128 DOR patients receiving assisted reproductive therapy were collected.All patients were treated with an antagonist scheme of super-ovulation.Patients were divided into melatonin group(n=56)and control group(n=72)according to whether melatonin(melatonin concentration 10^(-9)mol/L)was added into embryo culture medium.Results There was no statistically significant difference in oocytes fertilization rate and cleavage rate between the two groups during later embryo culture,but blastocyst formation rate(65.22%vs 56.16%)and high-quality blastocyst rate(52.96%vs 40.94%)in the melatonin group were higher than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the implantation rate(50.00%vs 38.67%)and clinical pregnancy rate(48.39%vs 46.00%)of blastocysts after freezing-thawing between the two groups,but the cycle number of high-quality blastocysts obtained in the melatonin group was higher than that in the control group(85.71%vs 69.44%),and the difference was statistically significant(P<0.05).Conclusion In a way,the application of melatonin in the in vitro culture of early embryos can promote the development of oocytes in patients with DOR,improve the quality of embryos,and finally substantially improve the therapeutic effect of such patients.