Mishra Vandana, Chirumamilla Lakshmi
a Obstetrics & Gyneocology , Nova IVI Fertility , Hyderabad , India.
Gynecol Endocrinol. 2018 Feb;34(2):100-102. doi: 10.1080/09513590.2017.1369514. Epub 2017 Aug 29.
The purpose of ovarian stimulation in IVF is to recover mature oocytes at metaphase II stage which are capable of fertilization either when mixed with sperm or after ICSI. However, there have been instances when even after controlled ovarian stimulation (COS) and correct administration of human chorionic gonadotrophin (hCG) trigger for final oocyte maturation, the oocytes were found to be arrested at germinal vesicle (GV) or metaphase I (MI) stage. Similar dilemma is faced in cases of empty follicle syndrome (either genuine or due to inadequate response), however, in this condition, there is no retrieval of oocytes despite presence of mature looking follicles. We present an interesting case where despite presence of normally growing follicles and documentation of correct response to trigger and rise in estradiol levels, two subsequent IVF cycles; one triggered with recombinant hCG and second with GnRH agonist, hCG failed to yield mature oocytes. Both cycles yielded expected number of oocytes but all at immature MI stage even after dual trigger.
体外受精中卵巢刺激的目的是获取处于减数分裂中期II阶段的成熟卵母细胞，这些卵母细胞无论是与精子混合还是在卵胞浆内单精子注射（ICSI）后都能够受精。然而，即使在进行了控制性卵巢刺激（COS）并正确给予人绒毛膜促性腺激素（hCG）以触发最终卵母细胞成熟后，仍有卵母细胞被发现停滞在生发泡（GV）期或减数分裂中期I（MI）期的情况。在空卵泡综合征（无论是真性还是由于反应不足）的病例中也面临类似困境，然而，在这种情况下，尽管存在看似成熟的卵泡，但却无法获取卵母细胞。我们呈现一个有趣的病例，尽管存在正常生长的卵泡，并且记录了对触发药物的正确反应以及雌二醇水平升高，但在随后的两个体外受精周期中；一个用重组hCG触发，另一个用促性腺激素释放激素（GnRH）激动剂加hCG触发，均未能产生成熟卵母细胞。两个周期都获得了预期数量的卵母细胞，但即使经过双重触发，所有卵母细胞都处于不成熟的MI期。
