CAJ | 학술논문

目的比较未成熟卵母细胞体外成熟(IVM)与常规体外受精-胚胎移植(IVF-ET)技术治疗多囊卵巢综合征( PCOS)不孕患者的实验室结果和临床结局.方法回顾性分析2007年1月-2010年12月在温州医学院附属第一医院生殖医学中心接受辅助生殖技术治疗的PCOS患者701个周期,其中行IVM治疗293个周期(IVM组),行IVF或卵母细胞胞质内单精子注射(ICSI)治疗408个周期(IVF/ICSI组),比较两组的周期移植率、平均获卵数、卵母细胞成熟率、受精率、卵裂率、优质胚胎率、胚胎种植率、移植周期妊娠率、妊娠结局及卵巢过度刺激综合征(OHSS)的发生率.结果 IVM组293个周期中,移植周期275个,周期移植率为93.9％；IVF/ICSI组408个周期中,移植周期342个,周期移植率为83.8％,两组比较,差异有统计学意义(P＜0.01).IVM组卵母细胞成熟率(56.64％)、卵裂率(88.08％)、优质胚胎率(38.72％)、胚胎种植率(17.8％)均显著低于IVF/ICSI组(分别为91.09％、94.91％、51.50％、25.4％),分别比较,差异均有统计学意义(P＜0.01).IVM组和IVF/ICSI组的移植周期临床妊娠率分别为37.8％(104/275)和44.2％(151/342),两组比较,差异无统计学意义(P＞0.05).IVM组平均获卵数为(12.9±6.5)个、受精率为76.52％,IVF/ICSI组分别为(12.9±7.9)个、70.75％,分别比较,差异均无统计学意义(P＞0.05).IVF/ICSI组有87个周期发生轻、中度OHSS,发生率为21.3％( 87/408),8个周期发生重度OHSS,发生率为2.0％(8/408).而IVM组无OHSS发生.结论 IVM与IVF/ICSI用于治疗PCOS不孕患者,可以获得相似的临床妊娠率.同时,IVM能完全避免OHSS的发生.
목적 비교미성숙란모세포체외성숙(IVM)여상규체외수정-배태이식(IVF-ET)기술치료다낭란소종합정( PCOS)불잉환자적실험실결과화림상결국.방법 회고성분석2007년1월-2010년12월재온주의학원부속제일의원생식의학중심접수보조생식기술치료적PCOS환자701개주기,기중행IVM치료293개주기(IVM조),행IVF혹란모세포포질내단정자주사(ICSI)치료408개주기(IVF/ICSI조),비교량조적주기이식솔、평균획란수、란모세포성숙솔、수정솔、란렬솔、우질배태솔、배태충식솔、이식주기임신솔、임신결국급란소과도자격종합정(OHSS)적발생솔.결과 IVM조293개주기중,이식주기275개,주기이식솔위93.9％；IVF/ICSI조408개주기중,이식주기342개,주기이식솔위83.8％,량조비교,차이유통계학의의(P＜0.01).IVM조란모세포성숙솔(56.64％)、란렬솔(88.08％)、우질배태솔(38.72％)、배태충식솔(17.8％)균현저저우IVF/ICSI조(분별위91.09％、94.91％、51.50％、25.4％),분별비교,차이균유통계학의의(P＜0.01).IVM조화IVF/ICSI조적이식주기림상임신솔분별위37.8％(104/275)화44.2％(151/342),량조비교,차이무통계학의의(P＞0.05).IVM조평균획란수위(12.9±6.5)개、수정솔위76.52％,IVF/ICSI조분별위(12.9±7.9)개、70.75％,분별비교,차이균무통계학의의(P＞0.05).IVF/ICSI조유87개주기발생경、중도OHSS,발생솔위21.3％( 87/408),8개주기발생중도OHSS,발생솔위2.0％(8/408).이IVM조무OHSS발생.결론 IVM여IVF/ICSI용우치료PCOS불잉환자,가이획득상사적림상임신솔.동시,IVM능완전피면OHSS적발생.
Objective To compare clinical and laboratory outcomes of in vitro maturation (IVM) with in vitro fertilization-embryo transfer (IVF-ET) in treatment of infertility associated with polycystic ovary syndrome (PCOS).Methods From Jan.2007 to Dec.2010,infertile patients with PCOS underwent 701 cycles in First Affiliated Hospital of Wenzhou Medical College were studied retrospectively.Those were divided into 293 cycles of IVM group and 408 cycles of IVF/intra-cytoplasmic sperm injection ( ICSI ) group.The average transplantation rate,mean number of retrieval oocytes,maturation rate,fertilization rate,cleavage rate,high quality embryo rate,embryo implantation rate,pregnancy rate per transfer,pregnancy outcomes and incidence of ovarian hyperstimulation syndrome (OHSS) of the two methods of treatment were compared between two groups.Results There were 275 cycles in IVM group and 342 cycles in IVF/ICSI group established embryo transfer.The transplantation rate was 93.9％ (275/293) in IVM group and 83.8％ (342/408) in IVF/ICSI,which reached statistical difference (P ＜ 0.01 ).The maturation rate of 56.64％,cleavage rate of 88.08％,high quality embryo rate of 38.72％ and embryo implantation rate of 17.8％ in IVM group were significantly lower than 91.09％,94.91％,51.50％ and 25.4％ in IVF/ICSI group (all P ＜ 0.01 ).The clinical pregnancy rate per transfer were 37.8％ (104/275) in IVM group and 44.2％ (151/342) in IVF/ICSI group,which did not show statistical difference (P＞0.05).The mean number of oocytes ( 12.9 ±6.5 vs.12.9 ±7.9) and fertilization rate (76.52％ vs.70.75％ ) didn't show significant difference between IVM group and IVF/ICSI group ( P ＞ 0.05 ).The 21.3％ ( 87/408 ) cycles presented mild to moderate OHSS and 2.0％ cycles (8/408) presented severe OHSS in IVF/ICSI group.While,no OHSS cycles were observed in IVM group.Conclusion IVM could get similar clinical pregnancy rates compared with IVF/ICSI in patient with PCOS,however,it can avoid occurrence of OHSS.