González-Ortega Claudia, Piña-Aguilar Raul E, Cancino-Villarreal Patricia, Pérez-Peña Efraín, Gutiérrez-Gutiérrez Antonio M
Institute of Sciences in Human Reproduction "Vida", León, Mexico.
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Taiwan J Obstet Gynecol. 2019 Mar;58(2):192-195. doi: 10.1016/j.tjog.2019.01.004.
In this study, we report an experience of 59 natural-cycle IVF combined with in vitro oocyte maturation (IVF/M) cycles in patients with PCOS requiring IVF recruited based on limitations to afford a conventional IVF treatment in a 9-years period. Results of IVF/M were compared with 164 cycles of IVF in PCOS patients.
In IVF/M cycles only hCG priming was used before oocyte recovery, with in vitro maturation of immature oocytes in a commercial medium. In conventional IVF group, recombinant FSH (rFSH) and GnRH agonist/antagonist for ovarian stimulation were used. In both groups, fertilization was achieved by intracytoplasmic sperm injection (ICSI) of mature oocytes and fresh embryos transferred at day 2 or day 3.
In all IVF/M cycles oocytes and transferable quality embryos were obtained, only in 6 IVF/M cycles mature oocytes were obtained at oocyte capture day. Clinical pregnancy rate per cycle was 39.0% vs 53.6% (p = 0.0682) and delivery rate per cycle was 30.5% vs 42.6% (p = 0.1209) in IVF/M and conventional IVF respectively. Patients with ovarian hyperstimulation syndrome (OHSS) were 0% in IVF/M vs 6.7% in conventional IVF (p = 0.0399).
Our experience in a private clinic in Mexico suggests that IVF/M can be a useful initial strategy to treat PCOS patients requiring IVF with comparable delivery rates to conventional IVF and a decreased risk of ovary hyperstimulation. IVF/M may be indicated to patients with limited resources paying without insurance for their infertility treatment.
在本研究中，我们报告了9年间对59例因经济限制而需要体外受精（IVF）的多囊卵巢综合征（PCOS）患者进行自然周期IVF联合体外卵母细胞成熟（IVF/M）周期的经验。将IVF/M的结果与164例PCOS患者的IVF周期进行比较。
在IVF/M周期中，仅在卵母细胞回收前使用hCG启动，未成熟卵母细胞在商业培养基中进行体外成熟培养。在传统IVF组中，使用重组促卵泡素（rFSH）和促性腺激素释放激素激动剂/拮抗剂进行卵巢刺激。两组均通过对成熟卵母细胞进行卵胞浆内单精子注射（ICSI）实现受精，并在第2天或第3天移植新鲜胚胎。
在所有IVF/M周期中均获得了卵母细胞和可移植质量的胚胎，仅在6个IVF/M周期中，在卵母细胞采集日获得了成熟卵母细胞。IVF/M组和传统IVF组的临床妊娠率分别为39.0%和53.6%（p = 0.0682），每周期分娩率分别为30.5%和42.6%（p = 0.1209）。IVF/M组卵巢过度刺激综合征（OHSS）患者为0%，而传统IVF组为6.7%（p = 0.0399）。
我们在墨西哥一家私立诊所的经验表明，IVF/M对于需要IVF治疗的PCOS患者可能是一种有用的初始策略，其分娩率与传统IVF相当，且卵巢过度刺激风险降低。IVF/M可能适用于那些没有保险支付不孕症治疗费用且资源有限的患者。
