体外受精中最小化/轻度卵巢刺激后MII期卵母细胞的效率
Efficiency of metaphase II oocytes following minimal/mild ovarian stimulation in vitro fertilization.
作者信息
Zhang John J, Yang Mingxue, Merhi Zaher
机构信息
Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY USA.
Division of Reproductive Biology, Department of Obstetrics and Gynecology, New York University School of Medicine, 180 Varick Street, sixth floor, New York, NY 10014 USA.
出版信息
Fertil Res Pract. 2016 Sep 1;2:2. doi: 10.1186/s40738-016-0025-6. eCollection 2016.
BACKGROUND
An inverse relationship between oocyte efficiency and ovarian response was reported in conventional IVF. The purpose of this study was to report metaphase II (MII) oocyte efficiency according to oocyte yield in minimal/mild stimulation IVF (mIVF) and to assess whether oocyte yield affects live birth rate (LBR).
METHODS
Infertile women ( = 264) aged < 39 years old with normal ovarian reserve who had mIVF were recruited. All participants received the same protocol for ovarian stimulation. All the embryos were cultured to the blastocyst stage and vitrified using a freeze-all approach. This was followed by a single blastocyst transferred to each participant in subsequent cycles over a 6-month period. Ovarian response was categorized according to the number of MII oocyte yield (low: 1-2, intermediate: 3-6 and high ≥ 7 MII oocytes). MII oocyte utilization rate was calculated as the number of live births divided by the number of MII oocytes produced after only one oocyte retrieval and subsequent transfers of vitrified/warmed blastocysts. The main outcome measure was cumulative LBR over a 6-month period.
RESULTS
Among all the participants, 1173 total retrieved oocytes (4.4 ± 0.2 per patient) resulted in 1019 (3.9 ± 0.2 per patient) total MII oocytes, a clinical pregnancy rate of 48.1 % and a LBR of 41.2 %. Oocyte utilization rate was inversely related to ovarian response where it was 30.3 % in the "low" vs. 9.3 % in the "intermediate" vs. 4.3 % in the "high" oocyte yield groups ( < 0.05). Implantation rate significantly dropped as the number of MII oocytes increased and was highest in the "low" oocyte yield group ( < 0.0001). Cumulative LBR was similar in "low," "intermediate," and "high" oocyte yield groups ( > 0.05). The number of MII oocytes had poor sensitivity and specificity for predicting a live birth.
CONCLUSION
These data extend the hypothesis of oocyte efficiency reported in conventional IVF protocols to mIVF protocols.
TRIAL REGISTRATION
Registration clinicaltrials.gov: NCT00799929.
背景
在传统体外受精（IVF）中，已报道卵母细胞效率与卵巢反应呈负相关。本研究的目的是报告在最小化/温和刺激IVF（mIVF）中，根据卵母细胞产量得出的中期II（MII）卵母细胞效率，并评估卵母细胞产量是否影响活产率（LBR）。
方法
招募年龄小于39岁、卵巢储备正常且接受mIVF的不孕女性（n = 264）。所有参与者接受相同的卵巢刺激方案。所有胚胎培养至囊胚期，并采用全冷冻方法进行玻璃化冷冻。随后在6个月的时间里，在后续周期为每位参与者移植单个囊胚。根据MII卵母细胞产量对卵巢反应进行分类（低：1 - 2个，中等：3 - 6个，高：≥7个MII卵母细胞）。MII卵母细胞利用率计算为活产数除以仅一次取卵后产生的MII卵母细胞数以及随后移植的玻璃化/解冻囊胚数。主要结局指标是6个月内的累积LBR。
结果
在所有参与者中，共获取1173个卵母细胞（每位患者4.4±0.2个），得到1019个（每位患者3.9±0.2个）MII卵母细胞，临床妊娠率为48.1%，LBR为41.2%。卵母细胞利用率与卵巢反应呈负相关，在“低”卵母细胞产量组为30.3%，“中等”组为9.3%，“高”组为4.3%（P < 0.05）。随着MII卵母细胞数量增加，着床率显著下降，在“低”卵母细胞产量组最高（P < 0.0001）。“低”、“中等”和“高”卵母细胞产量组的累积LBR相似（P > 0.05）。MII卵母细胞数量对预测活产的敏感性和特异性较差。
结论
这些数据将传统IVF方案中报道的卵母细胞效率假说扩展至mIVF方案。
试验注册
clinicaltrials.gov注册编号：NCT00799929。
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