Zhu Ru-ru, Xiao Shi-quan, Zhao Jun-zhao, Lin Jia, Wang Pei-yu, Jin Cong-cong, Jin Wu-min
Reproductive Medicine Center, Affiliated First Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Reproductive Medicine Center, Affiliated First Hospital of Wenzhou Medical University, Wenzhou 325000, China. Email:
Zhonghua Fu Chan Ke Za Zhi. 2013 Nov;48(11):833-7.
To compare the outcomes of in-vitro maturation (IVM) and in-vitro fertilization (IVF) after early follicular phase gonadotropin-releasing hormone agonist (GnRH-a) down-regulation in infertile patients with polycystic ovary syndrome (PCOS).
From July 2010 to December 2012, 72 infertile patients with PCOS undergoing assisted reproductive technology treatment in the Affiliated First Hospital of Wenzhou Medical University were enrolled in this study. The patients were divided into 2 groups, which were patients with early follicular phase down-regulation IVM (36 cases) at IVM group and early follicular phase down-regulation long protocol IVF (36 cases) at IVF group. The laboratory parameters and clinical outcomes were compared between two groups.
(1) Lab parameters: a total of 442 oocytes were retrieved in group IVM, and 560 were in group IVF. The rate of mature oocytes of 83.8% (469/560) and high-quality embryos of 70.9% (212/299) at group IVF were significantly higher than that of group IVM[54.1% (239/442) and 50.7% (73/144), retrospectively, P < 0.01]. In group IVM, the average duration of gonadotropin (Gn) was (2.8 ± 1.5) days and the average dosage of Gn was (285 ± 169) U, which were significantly lower than (11.0 ± 1.0) days and (1499 ± 165) U in group IVF (P < 0.01). The mean number of oocytes retrieved 12.8 ± 2.5, fertilization rate of 64.8% (155/239), and implantation rate of 31% (23/74) in group IVM and 15.6 ± 3.1, 65.5% (307/469), 31% (23/74) in group IVF, which did not reach statistical difference (P > 0.05) . (2) Clinical outcomes: the clinical pregnancy rate (17/31, 55%) of IVF group was not significantly higher than that 44% (14/32) at IVM group (P > 0.05). The abortion rate was 1/17 at Group IVF and 1/14 in group IVM, which did not show statistical difference. Women at IVM group has no ovarian hyper-stimulation syndrome (OHSS) cycle, group IVF has 31% (11/36) cycles presented moderate and severe OHSS.
Infertile patients with PCOS undergoing IVM and IVF treatment after early follicular phase GnRH-a down-regulation can get satisfactory laboratory and clinical outcome. In addition to short treatment cycle, IVM can also avoid the occurrence of OHSS completely, but it has a rising trend in the abortion rate. IVF has a high incidence of OHSS, meanwhile, it increases the dosage of gonadotropins.
比较多囊卵巢综合征（PCOS）不孕患者在卵泡早期促性腺激素释放激素激动剂（GnRH-a）降调节后体外成熟（IVM）和体外受精（IVF）的结局。
2010年7月至2012年12月，选取在温州医科大学附属第一医院接受辅助生殖技术治疗的72例PCOS不孕患者纳入本研究。将患者分为2组，IVM组为卵泡早期降调节IVM患者（36例），IVF组为卵泡早期降调节长方案IVF患者（36例）。比较两组的实验室参数和临床结局。
（1）实验室参数：IVM组共取卵442枚，IVF组共取卵560枚。IVF组成熟卵母细胞率83.8%（469/560）和优质胚胎率70.9%（212/299）显著高于IVM组[回顾性分析分别为54.1%（239/442）和50.7%（73/144），P<0.01]。IVM组促性腺激素（Gn）平均用药时间为（2.8±1.5）天，Gn平均用量为（285±169）U，显著低于IVF组的（11.0±1.0）天和（1499±165）U（P<0.01）。IVM组平均取卵数12.8±2.5，受精率64.8%（155/239），种植率31%（23/74）；IVF组平均取卵数15.6±3.1，受精率65.5%（307/469），种植率31%（23/74），差异无统计学意义（P>0.05）。（2）临床结局：IVF组临床妊娠率（17/31，55%）不显著高于IVM组的44%（14/32）（P>0.05）。IVF组流产率为1/17，IVM组为1/14，差异无统计学意义。IVM组无卵巢过度刺激综合征（OHSS）周期，IVF组有31%（11/36）周期出现中重度OHSS。
PCOS不孕患者在卵泡早期GnRH-a降调节后接受IVM和IVF治疗可获得满意的实验室和临床结局。IVM除治疗周期短外，还可完全避免OHSS的发生，但流产率有上升趋势。IVF发生OHSS的几率高，同时增加了促性腺激素的用量。
