生殖医学杂志

目的探讨卵母细胞体外成熟培养(IVM)在体外受精-胚胎移植(IVF-ET)周期中降低卵巢过度刺激综合征(OHSS)风险的应用价值。方法 51例IVF长方案超排卵过程中出现OHSS早期征象时,充分知情后按患者意愿分成两组,实验组为即刻停药并于当天注射人绒毛膜促性腺激素(HCG)36 h后取卵,改行卵母细胞IVM治疗的21个周期;对照组为继续按常规治疗的30个周期。比较两组促性腺激素(Gn)用药天数、用药量、受精率、周期取消率、临床妊娠率及OHSS发生率。结果两组年龄、不育年限、基础内分泌、受精率、优质胚胎率、临床妊娠率均无统计学差异(P>0.05),但实验组的卵泡刺激素(FSH)总用量、FSH用药天数、获卵数、OHSS(中、重度)发生率均低于对照组(P<0.05),并且实验组周期ET取消率也显著低于对照组(P<0.05)。结论在常规IVF周期超排卵中,当出现OHSS早期征象时改行卵母细胞IVM可显著减少促排卵药物的使用量,降低OHSS的发生风险及周期移植取消率,同时获得较好的临床妊娠率。

Objective:To explore the effect of oocytes in vitro maturation in preventing ovarian hyperstimulation syndrome in IVF-ET cycles. Methods:The long protocol of controlled ovarian hyperstimulation method was applied for 51 infertile patients.When early signs of occurrence of ovarian hyperstimulation syndrome(OHSS) appeared,the patients were divided into two groups according to their own selection.The oocytes were aspirated and maturated in vitro 36 hours after HCG administration in experimental group(21 cycles).The routine IVFET protocol was continuously used in the control group(30 cycles).Clinical parameters including total days and dosages of gonadotropin(Gn) used,fertilization rate,clinical pregnancy rate(CPR),occurrence of OHSS rate and canceled cycle rate were compared between the two groups. Results:There were no significant differences in basic reproductive hormone levels,the fertilization rate,the good embryo rate and CPR between the experimental and control group.The dosages of Gn, stimulation days and number of acquired oocytes in experimental group were much less than those in control group(P<0.05).The occurrence of OHSS rate and the canceled cycle rate in experimental group were significantly lower than those in the control group(P<0.05). Conclusions:Follicle aspiration associated with maturation in vitro can not only reduce the dosage of Gn,but also prevent OHSS occurrence in patients undergoing IVF-ET without affecting pregnancy outcome.