IVF Laboratory, IVIRMA-Valencia, Valencia 46015, Spain.
IVF Laboratory, IVIRMA-Valencia, Valencia 46015, Spain; IVF Laboratory, IVF Spain, Alicante 03540, Spain.
Reprod Biomed Online. 2018 Dec;37(6):667-676. doi: 10.1016/j.rbmo.2018.08.023. Epub 2018 Oct 6.
How can laboratory and clinical outcomes of spontaneously, early maturing germinal-vesicle oocytes and sibling in-vivo-matured (metaphase II [MII]) oocytes be quantified and compared?
A prospective, non-randomized intra-cohort study of oocytes from women aged 38 years or younger, with six or fewer MII oocytes and four or more germinal vesicles retrieved. No indication was identified for genetic tests or oocyte or embryo cryopreservation. The study was carried out at IVIRMA-Valencia. Early maturing germinal vesicles were selected for reproductive purposes. In vitro- and in-vivo MII oocytes were fertilized. After time-lapse culture, hatching blastocysts from germinal vesicles were biopsied for aneuploidy screening and vitrified. Laboratory and clinical outcomes were compared according to oocyte origin.
Almost 70% of germinal vesicles had matured early and spontaneously, and had comparable in vitro-outcomes and morphokinetics to sibling in vivo-matured oocytes. Fifty per cent of biopsied blastocysts were euploid. Germinal-vesicle rescue increased the number of MII oocytes per cycle to 3.9, finally adding one extra-blastocyst per cycle. A live birth confirmed the feasibility of this approach. Further data, however, are needed to quantify its real contribution to standard intracytoplasmic sperm injection cycles. Nevertheless, 40% of patients obtained either an immediate advantage (reduction of cancellation rate) or long-term benefit (availability of extra blastocysts of attempts).
Germinal-vesicle rescue can be considered as a complementary approach when folliculometry (expected) and number of MII (observed) are unequal.
如何量化和比较自然、早期成熟的生发泡卵母细胞和同胞体内成熟（MII 期）卵母细胞的实验室和临床结局？
一项前瞻性、非随机的队列内研究，纳入年龄在 38 岁及以下、有 6 枚或 6 枚以下 MII 卵母细胞和 4 枚或 4 枚以上生发泡的女性的卵母细胞。没有进行基因检测或卵母细胞或胚胎冷冻保存的指征。该研究在 IVIRMA-Valencia 进行。选择早期成熟的生发泡用于生殖目的。体外和体内 MII 卵母细胞受精。在延时培养后，从生发泡中孵化的囊胚进行非整倍体筛查和玻璃化。根据卵母细胞来源比较实验室和临床结局。
近 70%的生发泡自然、早期成熟，其体外结局和形态动力学与同胞体内成熟的卵母细胞相当。50%活检的囊胚为整倍体。生发泡挽救增加了每个周期的 MII 卵母细胞数量至 3.9 个，最终每个周期增加一个额外的囊胚。一次活产证实了这种方法的可行性。然而，还需要更多的数据来量化其对标准胞浆内单精子注射周期的真正贡献。尽管如此，40%的患者立即受益（降低取消率）或长期受益（增加尝试的额外囊胚）。
当卵泡计数（预期）和 MII 数量（观察）不相等时，生发泡挽救可以被视为一种补充方法。
