Rosen Mitchell P, Shen Shehua, Dobson Anthony T, Rinaudo Paolo F, McCulloch Charles E, Cedars Marcelle I
Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94115, USA.
Fertil Steril. 2008 Sep;90(3):684-90. doi: 10.1016/j.fertnstert.2007.02.011. Epub 2008 Feb 4.
To quantitatively assess the impact of follicle size on oocyte maturation, fertilization, and embryo quality.
Prospective study.
Academic medical center.
PATIENT(S): Couples undergoing ovarian stimulation and in vitro fertilization (IVF).
INTERVENTION(S): A total of 235 cycles were monitored prospectively, and 2934 oocytes were collected from five groups of follicle size. Repeated measures multivariate analyses were used to compare the smaller follicle sizes with the lead follicle.
MAIN OUTCOME MEASURE(S): Oocyte maturation, fertilization, and embryo quality.
RESULT(S): Compared with the lead follicular group (>18 mm), the odds of a mature oocyte from a 16 to 18 mm size follicle were 37% and declined progressively with each size. The odds of fertilization of oocytes from follicles 16 to 18 mm in size was 28% less than the lead group and decreased with each size. The rate of polyspermy with conventional insemination was increased for the smaller follicular groups (adjusted odds ratio = 2.37). Follicle size did not predict embryo cell number, but embryos from smaller follicles had a statistically significantly higher fragmentation compared with the lead group.
CONCLUSION(S): The lead follicular group was most likely to have a mature oocyte that was capable of fertilization and best suited for development into a high-quality embryo. The smaller follicles were capable of producing metaphase II oocytes that could fertilize, but at rates approaching only 60% that of the lead follicular group.
定量评估卵泡大小对卵母细胞成熟、受精及胚胎质量的影响。
前瞻性研究。
学术医疗中心。
接受卵巢刺激及体外受精（IVF）的夫妇。
前瞻性监测共235个周期，从五组不同大小卵泡中收集了2934个卵母细胞。采用重复测量多变量分析，将较小卵泡大小与主导卵泡进行比较。
卵母细胞成熟、受精及胚胎质量。
与主导卵泡组（>18mm）相比，16至18mm大小卵泡产生成熟卵母细胞的几率为37%，且随卵泡大小减小而逐渐下降。16至18mm大小卵泡的卵母细胞受精几率比主导组低28%，并随卵泡大小减小而降低。较小卵泡组采用常规授精时多精受精率增加（调整优势比=2.37）。卵泡大小不能预测胚胎细胞数量，但与主导组相比，较小卵泡来源的胚胎碎片率在统计学上显著更高。
主导卵泡组最有可能拥有能够受精且最适合发育成高质量胚胎的成熟卵母细胞。较小卵泡能够产生可受精的中期II卵母细胞，但其受精率仅接近主导卵泡组的60%。
