van der Gaast M H, Eijkemans M J C, van der Net J B, de Boer E J, Burger C W, van Leeuwen F E, Fauser B C J M, Macklon N S
Erasmus Medical Center, Center of Reproductive Medicine, 3015 GD Rotterdam, The Netherlands.
Reprod Biomed Online. 2006 Oct;13(4):476-80. doi: 10.1016/s1472-6483(10)60633-5.
Ovarian stimulation in IVF allows selection of embryos for transfer, but may have detrimental effects on oocyte and embryo quality and endometrial receptivity. This study investigated the optimal response to ovarian stimulation in terms of number of oocytes for achieving pregnancy in a first IVF cycle. Data from 7422 women who underwent their first IVF cycle for standard indications were analysed. All had been treated with exogenous gonadotrophins and gonadotrophin releasing hormone (GnRH) agonist co-treatment in a long down-regulation protocol between 1990 and 1995. Pregnancy rates in relation to the number of obtained oocytes were adjusted for age, fecundity, subfertility cause, gonadotrophin dosage, type of luteal support, and number of transferred embryos by multivariate analysis. Of the 7422 women who underwent oocyte retrieval, overall 85% had an embryo transfer and 24% conceived. The highest pregnancy rates per embryo transfer and per started cycle were observed when 13 oocytes were obtained (31 and 28%, respectively). This study supports the concept of an optimal range of oocytes obtained in response to ovarian stimulation for IVF, below and above which outcomes are compromised.
体外受精中的卵巢刺激可用于选择用于移植的胚胎，但可能对卵母细胞、胚胎质量及子宫内膜容受性产生不利影响。本研究调查了在首次体外受精周期中，就实现妊娠而言，卵巢刺激产生最佳反应时的卵母细胞数量。分析了7422名因标准指征接受首次体外受精周期治疗的女性的数据。所有患者在1990年至1995年间均采用长效降调节方案，接受了外源性促性腺激素和促性腺激素释放激素（GnRH）激动剂联合治疗。通过多因素分析，对年龄、生育力、亚生育原因、促性腺激素剂量、黄体支持类型及移植胚胎数量进行校正后，得出与获得的卵母细胞数量相关的妊娠率。在接受卵母细胞采集的7422名女性中，总体上85%进行了胚胎移植，24%成功受孕。当获得13个卵母细胞时，观察到每次胚胎移植和每个起始周期的妊娠率最高（分别为31%和28%）。本研究支持这样一种概念，即体外受精时卵巢刺激获得的卵母细胞数量存在一个最佳范围，低于或高于此范围，结局都会受到影响。
