Clínica EUGIN, Travessera de les Corts 322, 08029, Barcelona, Spain.
J Assist Reprod Genet. 2019 Sep;36(9):1927-1934. doi: 10.1007/s10815-019-01540-8. Epub 2019 Aug 2.
The objective of this study is to analyze the potential of immature, denuded, post-GVBD (germinal vesicle breakdown) oocytes (including prometaphase I, metaphase I, and prometaphase II stages) to result live birth after in vitro maturation. Furthermore, we compared two culture media to identify which of them provides better reproductive outcomes when used for in vitro maturation.
We performed a retrospective cohort study including 4022 IVF-ICSI (in vitro fertilization-intracytoplasmic sperm injection) cycles between 2011 and 2015. A total of 4450 immature post-GVBD oocytes from 1442 cycles were cultured in vitro; of these, 2364 oocytes reached MII (metaphase II) stage (IVMC oocytes, in vitro meiotic completion) and were fertilized. Overall, 3933 embryo transfers were performed: 3579 were embryos derived from MII oocytes (ET-MII); 264 were embryos derived from MII + IVMC oocytes (ET-MIX), and 90 embryos from IVMC oocytes (ET-IVMC). In total, 399 IVMC embryos were transferred.
Maturation rate for immature post-GVBD oocytes was 54.1%. G-2™PLUS (Vitrolife) medium provided significantly higher maturation rate (p < 0.001) than G-IVF™PLUS (Vitrolife) (65.7% vs. 42.5%, p < 0.001). Embryos in ET-IVMC in cleavage stage had an average morphological score of 6.8/10 (7.7 in ET-MII; p < 0.001). Regarding reproductive outcomes, ET-IVMC gave 11.1% biochemical pregnancy rate, 10.0% clinical pregnancy rate, 7.8% ongoing pregnancy rate, and 5.6% live birth rate.
Embryos arising from IVMC oocytes resulted in a live birth rate of 5.6%. We suggest that in vitro maturation of denuded immature post-GVBD oocytes should be performed at the very least when few MII are collected, and likely in all patients, as they provide acceptable maturation and fertilization rates, and a sizeable increase in live birth.
本研究旨在分析生发泡破裂（GVBD）后未成熟、裸露的卵母细胞（包括前期 I 期、中期 I 期和前期 II 期）经体外成熟后获得活产的潜力。此外，我们比较了两种培养介质，以确定哪种在体外成熟时提供更好的生殖结果。
我们进行了一项回顾性队列研究，纳入了 2011 年至 2015 年期间的 4022 个体外受精-胞浆内精子注射（IVF-ICSI）周期。共培养了 1442 个周期中的 4450 个未成熟的 GVBD 后卵母细胞；其中 2364 个卵母细胞达到 MII（中期 II）期（IVMC 卵母细胞，体外减数分裂完成）并受精。共进行了 3933 次胚胎移植：3579 次为来自 MII 卵母细胞的胚胎（ET-MII）；264 次为来自 MII+IVMC 卵母细胞的胚胎（ET-MIX），90 次为来自 IVMC 卵母细胞的胚胎（ET-IVMC）。共转移了 399 个 IVMC 胚胎。
GVBD 后未成熟卵母细胞的成熟率为 54.1%。G-2™PLUS（Vitrolife）培养基提供的成熟率显著高于 G-IVF™PLUS（Vitrolife）（65.7%比 42.5%，p<0.001）。ET-IVMC 中处于卵裂阶段的胚胎平均形态评分 6.8/10（ET-MII 为 7.7；p<0.001）。关于生殖结果，ET-IVMC 的生化妊娠率为 11.1%，临床妊娠率为 10.0%，持续妊娠率为 7.8%，活产率为 5.6%。
来自 IVMC 卵母细胞的胚胎的活产率为 5.6%。我们建议，至少在收集的 MII 较少时，应进行裸露的不成熟 GVBD 后卵母细胞的体外成熟，而且可能在所有患者中都应进行，因为它们提供了可接受的成熟和受精率，并显著增加了活产率。
