Kok Jeroen D, Looman Caspar W N, Weima Sjerp M, te Velde Egbert R
Division of Obstetrics, Neonatology and Gynecology, Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Fertil Steril. 2006 Apr;85(4):918-24. doi: 10.1016/j.fertnstert.2005.09.035.
To investigate the possible negative effects of a strong ovarian response on oocyte quality.
Retrospective study.
Tertiary academic center.
PATIENT(S): A total of 1,894 women (IVF, n = 1,544; ICSI, n = 350) who underwent their first ovarian stimulation cycle during the period 1995-2002.
INTERVENTION(S): Standardized controlled ovarian stimulation with urinary FSH or recombinant FSH after pituitary down-regulation, followed by IVF/intracytoplasmic sperm injection (ICSI) and ET.
MAIN OUTCOME MEASURE(S): Fertilization rate, fraction of high-quality embryos, and implantation rate.
RESULT(S): Using multivariate logistic regression, we analyzed the effect, expressed as an odds ratio (OR), of the number of oocytes obtained (i.e., ovarian response) on the outcome measures. No effect of the response on the ongoing implantation rate or fraction of high-quality embryos was observed. Both in IVF (OR = 0.81, 95% confidence interval [CI] 0.75-0.87) and in ICSI (OR = 0.88, 95% CI 0.76-1.00), a negative effect of increasing ovarian response was seen on the fertilization rate per oocyte obtained. However, no negative effect was observed on the fertilization rate per oocyte injected in ICSI (OR = 1.00, 95% CI 0.87-1.14). The fraction of immature oocytes rises from 3.9%, in women with < or = 3 oocytes, to 26% in women with > 20 oocytes.
CONCLUSION(S): Oocytes from high responders contain a greater fraction of immature oocytes, but pregnancy outcome is not impaired.
研究卵巢过度反应对卵母细胞质量可能产生的负面影响。
回顾性研究。
三级学术中心。
1995年至2002年期间共1894名进行首次卵巢刺激周期的女性（体外受精[IVF]，n = 1544；卵胞浆内单精子注射[ICSI]，n = 350）。
垂体降调节后使用尿促卵泡素或重组促卵泡素进行标准化控制性卵巢刺激，随后进行IVF/卵胞浆内单精子注射（ICSI）及胚胎移植（ET）。
受精率、优质胚胎比例及着床率。
采用多因素逻辑回归分析，我们分析了所获卵母细胞数量（即卵巢反应）对各项观察指标的影响，以比值比（OR）表示。未观察到反应对持续着床率或优质胚胎比例有影响。在IVF组（OR = 0.81，95%置信区间[CI] 0.75 - 0.87）和ICSI组（OR = 0.88，95% CI 0.76 - 1.00）中，均观察到卵巢反应增加对所获每个卵母细胞的受精率有负面影响。然而，在ICSI组中，对每个注射卵母细胞的受精率未观察到负面影响（OR = 1.00，95% CI 0.87 - 1.14）。未成熟卵母细胞比例从卵母细胞≤3个的女性中的3.9%升至卵母细胞>20个的女性中的26%。
高反应者的卵母细胞中未成熟卵母细胞比例更高，但妊娠结局未受损害。
