Ziebe Søren, Lundin Kersti, Janssens Ronny, Helmgaard Lisbeth, Arce Joan-Carles
Fertility Clinic, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Hum Reprod. 2007 Sep;22(9):2404-13. doi: 10.1093/humrep/dem221. Epub 2007 Jul 19.
There are limited data on the impact of different gonadotrophin preparations on embryo quality.
This evaluation was part of a randomized, assessor-blind, multinational trial, conducted in 731 women undergoing IVF after stimulation with highly purified human menopausal gonadotropin (HP-hMG; MENOPUR) (n = 363) or recombinant FSH (rFSH; GONAL-F) (n = 368). Ongoing pregnancy was the primary end-point [HP-hMG 27% and rFSH 22%; odds ratio (OR) (95% confidence interval, CI) 1.25 (0.89-1.75)]. All 7535 oocytes retrieved were evaluated daily until day 3 (embryo transfer) in a blinded manner both by local site embryologists and a central panel of three embryologists.
The proportion of top-quality embryos per oocyte retrieved was higher with HP-hMG (11.3%) compared with rFSH (9.0%) (P = 0.044) in the local assessment, but comparable in the central assessment (9.5 and 8.0%, respectively). Significant differences in favour of HP-hMG were observed for number of blastomeres and degree of fragmentation, while uniformity of blastomere sizes, localization of fragments, frequency of multinucleation and homogeneous cytoplasm were comparable between HP-hMG and rFSH. The live birth, ongoing pregnancy and ongoing implantation rates for top-quality embryos were higher with HP-hMG than rFSH [48 versus 32% (P = 0.038), 48 versus 32% (P = 0.038), 41 versus 27% (P = 0.032)]. Both the proportion of embryos with at least 50% surviving blastomeres after cryopreservation and embryos resuming mitosis were more frequent with HP-hMG compared with rFSH.
Composition of gonadotrophin preparations used during ovarian stimulation has an impact on some embryo quality parameters. The capacity to implant of the top-quality embryos derived from stimulation with HP-hMG appears to be improved, although the mechanism needs to be elucidated.
关于不同促性腺激素制剂对胚胎质量的影响，相关数据有限。
本评估是一项随机、评估者盲法的多国试验的一部分，该试验纳入了731名接受体外受精（IVF）的女性，她们分别接受高纯度人绝经期促性腺激素（HP-hMG；果纳芬）（n = 363）或重组促卵泡激素（rFSH；普利康）（n = 368）刺激。持续妊娠是主要终点[HP-hMG组为27%，rFSH组为22%；优势比（OR）（95%置信区间，CI）为1.25（0.89 - 1.75）]。所有7535枚取出的卵母细胞在第3天（胚胎移植）前每天由当地胚胎学家和由三名胚胎学家组成的中央小组以盲法进行评估。
在局部评估中，与rFSH（9.0%）相比，HP-hMG组每枚取出卵母细胞获得的优质胚胎比例更高（11.3%）（P = 0.044），但在中央评估中两者相当（分别为9.5%和8.0%）。在卵裂球数量和碎片程度方面观察到显著有利于HP-hMG的差异，而HP-hMG和rFSH在卵裂球大小均匀性、碎片定位、多核化频率和细胞质均匀性方面相当。HP-hMG组优质胚胎的活产率、持续妊娠率和持续着床率高于rFSH组[分别为48%对32%（P = 0.038），48%对32%（P = 0.038），41%对27%（P = 0.032）]。与rFSH相比，HP-hMG组冷冻保存后至少有50%存活卵裂球的胚胎比例以及恢复有丝分裂的胚胎比例更高。
卵巢刺激期间使用的促性腺激素制剂的组成对一些胚胎质量参数有影响。尽管机制有待阐明，但源自HP-hMG刺激的优质胚胎的着床能力似乎有所提高。
