Lee Joseph A, Sekhon Lucky, Grunfeld Lawrence, Copperman Alan B
aReproductive Medicine Associates of New York bDepartment of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York, USA.
Curr Opin Obstet Gynecol. 2014 Jun;26(3):168-73. doi: 10.1097/GCO.0000000000000062.
To evaluate current and previous findings related to a timely implementation of in-vitro maturation (IVM) of germinal vesicle, metaphase I and metaphase II oocytes with an optimal cryopreservation to determine whether IVM should be attempted prior to (fresh IVM) or IVM after cryopreservation (postthaw IVM). Mitochondrion, chromatin and spindle formation in both groups were interpreted from referenced studies to establish best management of all oocytes.
The postthaw survival of germinal vesicle, metaphase I, fresh IVM-metaphase II and control metaphase II oocytes did not differ significantly [83.3% (n=9), 86.7% (n=12), 83% (n=57) and 86% (n=68), respectively]. Overall, combined survival and maturation were significantly higher (P<0.05) in the fresh IVM group at 63.8% (44 of 69) compared with the postthaw IVM group at 33.3% (nine of 27).
Conservation of retrieved immature oocytes after vaginal oocyte retrieval has become a major concern for patients, as they strive to maximize the reproductive viability of all oocytes obtained during treatment. Oocyte cryopreservation is important for patients at risk of ovarian cancer, elective fertility preservation and potentially for ovum donation. The superior maturation rate of germinal vesicle and metaphase I oocytes in the fresh IVM vs. postthaw groups provides strong impetus to mature oocytes to the metaphase II stage prior to cryopreservation.
评估与及时实施生发泡期、减数分裂中期Ⅰ和减数分裂中期Ⅱ卵母细胞的体外成熟（IVM）以及最佳冷冻保存相关的当前和既往研究结果，以确定是否应在冷冻保存前尝试IVM（新鲜IVM）或冷冻保存后进行IVM（解冻后IVM）。通过参考研究对两组中的线粒体、染色质和纺锤体形成进行解读，以确立对所有卵母细胞的最佳管理方法。
生发泡期、减数分裂中期Ⅰ、新鲜IVM-减数分裂中期Ⅱ和对照减数分裂中期Ⅱ卵母细胞解冻后的存活率无显著差异[分别为83.3%（n = 9）、86.7%（n = 12）、83%（n = 57）和86%（n = 68）]。总体而言，新鲜IVM组的联合存活率和成熟率显著更高（P<0.05），为63.8%（69个中的44个），而解冻后IVM组为33.3%（27个中的9个）。
阴道取卵后回收的未成熟卵母细胞的保存已成为患者的主要关注点，因为他们努力使治疗期间获得的所有卵母细胞的生殖活力最大化。卵母细胞冷冻保存对于有卵巢癌风险的患者、选择性生育力保存以及潜在的卵子捐赠都很重要。新鲜IVM组与生发泡期和减数分裂中期Ⅰ卵母细胞解冻后组相比，成熟率更高，这有力地推动了在冷冻保存前将卵母细胞成熟至减数分裂中期Ⅱ阶段。
