未成熟卵体外成熟技术在卵巢高反应患者IVF-ET中的应用  

In vitro maturation of human immature oocyte in in vitro fertilization and embryo transfer

作　　者：黄绘[1] 洪焱[1] 冯玉蓉[1] 刘敏利[1] 胡皓睿 潘世春 

机构地区：[1]贵州省贵阳市妇幼保健院生殖中心,550003

出　　处：《中国计划生育学杂志》2012年第6期401-403,406,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨未成熟卵体外成熟(IVM)技术在卵巢高反应患者体外受精-胚胎移植(IVF-ET)中的应用价值。方法:在IVF-ET促排治疗中,对双卵巢卵泡数过多,有可能发生卵巢过度刺激综合征(OHSS)或继续治疗可能发生重度OHSS的患者,根据其意愿即刻停药,全部取卵改行IVM治疗12个周期(A组)或取部分小卵泡改行IVM治疗,同时保留部分卵泡继续行IVF-ET常规治疗18个周期(B组)。小卵泡体外培养成熟后,通过卵胞浆内单精子注射(ICSI)获得受精卵并行胚胎移植或冷冻。统计分析未成熟卵的成熟率、卵母细胞的受精率、胚胎的发育情况及临床结局。结果:两组30个取卵周期,共获未成熟卵240个,经IVM、ICSI和体外培养后,成熟率、受精率、正常卵裂率及优质胚胎率分别为61.25%(147/240),77.55%(114/147),92.98%(106/114)和29.25%(31/106)。A组8例行IVM新鲜胚胎移植(8周期)4例临床妊娠,A、B两组有8例行IVM解冻胚胎移植(9周期)3例临床妊娠,已有3例分娩。A组12例无OHSS发生,促性腺激素用量少于B组,B组18例中3例有OHSS风险而取消胚胎移植。结论:对常规IVF促排周期中卵巢高反应患者及时改行IVM,可以避免周期取消及OHSS的发生,减少促排卵药物的使用量,同时获得较好的临床妊娠率。Objective ： To explore the clinical application of in vitro oocyte maturation （IVM） technique in in vitro fertilization-embryo transfer （IVF-ET）. Methods： In the treatment of IVF -ET, women who canceled the treatment cycle due to high risk of developing ovarian hyperstimulation syndrome （OHSS） were divided into two groups according to their choices. Women in group A （n = 12） underwent oocyte retrieval guided by transvaginal ultrasound for all small follicles and treated with IVM technique for 12 cycles. Women in group B （n = 18 ） were performed oocyte retrieval for some small follicles treated with IVM technique and kept on IVF - ET with some follicles for 18 cycles. Immature oocytes were cultured in vitro after occyte pick - up. Intracytoplasmic sperm injection was performed, and good quality embryos were transferred or cryopreserved by fast - freezing method subsequently. The mature rate of immature oocytes, fertilization rate of matured oocytes, embryo development and the clinical outcome were evaluated. Results ： A total of 240 immature oocytes were obtained in 30 oocyte pick - up cy- cles. The overall maturation rate, fertilization rate, cleavage rate and good quality embryo rate were 61.25% （147/240）, 77.55% （114/147）, 92.98% （106/114） and 29.25 % （31/106）, respectively. Conventional embryo transfer was per-formed in 8 fresh cycles and 9 frozen - thawed cycles. Three clinical pregnancies were achieved. And three women underwent delivery successfully. There were no OHSS found and significantly less gonadotropin used in group A. Conclusion： IVM tech- nique is an effective compensatory method in IVF - ET treatment for women with a high response, which can reduce the occur-rence of both cycle cancellation and OHSS. And good clinical pregnant rate could be achieved with less gonadotropin.

关 键 词：卵巢高反应 未成熟卵 体外成熟 体外受精 胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]