Shebl Omar, Sifferlinger Ida, Habelsberger Alwin, Oppelt Peter, Mayer Richard B, Petek Erwin, Ebner Thomas
Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria.
Institute of Human Genetics, Medical University, Graz, Austria.
Acta Obstet Gynecol Scand. 2017 Jun;96(6):736-744. doi: 10.1111/aogs.12941. Epub 2016 Jul 22.
Endometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome.
Oocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997.
Patients with endometriosis had a significantly lower rate of mature oocytes (p < 0.03) and morphologically normal oocytes (p < 0.001). In particular, brownish oocytes (p < 0.009; stage I-IV) and the presence of refractile bodies (p < 0.001; stage IV) were found to be increased. Endometriosis stage IV was associated with significantly worse-quality oocytes than stages I-III (p < 0.01). Fertilization was significantly reduced in conventional in vitro fertilization but not in intracytoplasmic sperm injection (p < 0.03). This was due to lower fertilization rates in stage III-IV endometriosis compared with stage I-II (p < 0.04). No difference was observed with respect to rates of implantation, clinical pregnancy, miscarriage, live birth, and malformation.
Endometriosis patients, in particular those with severe endometriosis, present lower-quality oocytes. Once fertilized, no impairment of further preimplantation embryo development and pregnancy outcome right up to healthy live birth rate has to be expected.
子宫内膜异位症影响着高达15%的育龄女性。目前明显缺乏关于辅助生殖中子宫内膜异位症患者卵母细胞形态学参数的研究。本研究的一个目的是描述患有子宫内膜异位症且接受卵胞浆内单精子注射的患者的卵母细胞形态。此外，分析子宫内膜异位症对体外受精结果的影响。然后将体外受精和卵胞浆内单精子注射患者与无子宫内膜异位症的对照组进行匹配，以突出子宫内膜异位症与妊娠结局之间可能存在的关联。
在两组中评估子宫内膜异位症患者的卵母细胞形态。研究组和对照组各有129个体外受精/卵胞浆内单精子注射周期。根据抗苗勒管激素、女性年龄、既往治疗周期和受精方式对患者进行匹配。根据1997年修订的美国生殖医学学会指南对子宫内膜异位症进行分级。
子宫内膜异位症患者成熟卵母细胞（p<0.03）和形态正常卵母细胞（p<0.001）的比例显著较低。特别是，发现褐色卵母细胞（p<0.009；I-IV期）和折光体的存在（p<0.001；IV期）有所增加。与I-III期相比，IV期子宫内膜异位症与卵母细胞质量明显较差相关（p<0.01）。常规体外受精的受精率显著降低，但卵胞浆内单精子注射的受精率未降低（p<0.03）。这是由于III-IV期子宫内膜异位症的受精率低于I-II期（p<0.04）。在着床率、临床妊娠率、流产率、活产率和畸形率方面未观察到差异。
子宫内膜异位症患者，尤其是患有严重子宫内膜异位症的患者，卵母细胞质量较低。一旦受精，预计直至健康活产率的进一步着床前胚胎发育和妊娠结局不会受到损害。
