在有/无 PCOS 的生育力低下女性中，轻度刺激 IVF/M 周期与早期胚胎停滞之间的关联。

Association between mild stimulated IVF/M cycle and early embryo arrest in sub fertile women with/without PCOS.

机构信息

Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.

Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.

出版信息

Reprod Biol Endocrinol. 2020 Jul 15;18(1):71. doi: 10.1186/s12958-020-00622-y.

DOI:10.1186/s12958-020-00622-y

PMID:32669130

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7362506/

Abstract

BACKGROUND

The in vitro maturation (IVM) technique has physical and financial benefits, but a lower efficiency and outcome that is still unclear whether it is related to polycystic ovary syndrome (PCOS) itself or the IVM procedure. In this study, we analyzed the clinical and laboratory outcomes of an optimized IVM protocol in patients with and without PCOS. We also discussed the possible reasons for early embryo arrest in the IVM cycle.

METHODS

This prospective study involved 58 PCOS patients and 56 non-PCOS patients who underwent mild stimulated IVF combined IVM (IVF/M) cycles. The clinical and laboratory outcomes were compared between the two groups. Also, metaphase II (MII) oocytes were obtained after IVM from the two groups, and in vivo MII oocytes randomly collected from IVF patients were examined for mitochondrial function using a laser scanning confocal microscope (LSCM). The aneuploidy rate for arrested cleavage embryos from IVM and IVF oocytes were screened using Next Generation Sequencing (NGS).

RESULTS

Mildly stimulated IVF/M resulted in cumulative clinical pregnancy and implantation rates (40.2, 28.7% in the PCOS group vs. 41.9, 36% in the non-PCOS group), respectively. The blastocyst formation rates were comparable (28% vs. 28.2%) in PCOS and non-PCOS groups, respectively. Using LSCM, there was a significant decrease in the mitochondrial membrane potential of IVM oocytes compared with the control IVF oocytes (P < 0.001), but no significant difference between the PCOS and non-PCOS groups. The NGS showed that the aneuploidy rates were comparable (75, 75, and 66.6%) in IVM-PCOS, IVM-non-PCOS, and control IVF arrested embryos, respectively.

CONCLUSIONS

The mildly stimulated IVF/M protocol produced acceptable clinical outcomes in PCOS and non-PCOS patients. IVM itself rather than the PCOS condition adversely affected the embryo development through its effect on mitochondrial function, which appeared to be a possible cause for the embryo arrest in the IVM cycles rather than chromosomal aneuploidy.

摘要

背景

体外成熟（IVM）技术具有物理和经济优势，但效率较低，其结果尚不清楚是与多囊卵巢综合征（PCOS）本身有关，还是与 IVM 过程有关。在这项研究中，我们分析了优化的 IVM 方案在 PCOS 患者和非 PCOS 患者中的临床和实验室结果。我们还讨论了 IVM 周期中早期胚胎停滞的可能原因。

方法

这项前瞻性研究涉及 58 名 PCOS 患者和 56 名非 PCOS 患者，他们接受了轻度刺激的体外受精联合 IVM（IVF/M）周期。比较了两组患者的临床和实验室结果。此外，从两组患者中获得 IVM 后的中期 II（MII）卵母细胞，并使用激光扫描共聚焦显微镜（LSCM）检查来自 IVF 患者的体内随机采集的 MII 卵母细胞的线粒体功能。使用下一代测序（NGS）筛选 IVM 和 IVF 卵母细胞中停滞的卵裂胚胎的非整倍体率。

结果

轻度刺激的 IVF/M 分别导致累积临床妊娠率和着床率（PCOS 组为 40.2%，28.7%；非 PCOS 组为 41.9%，36%）。囊胚形成率在 PCOS 和非 PCOS 组分别相似（28%对 28.2%）。使用 LSCM，与对照 IVF 卵母细胞相比，IVM 卵母细胞的线粒体膜电位显著降低（P<0.001），但 PCOS 组和非 PCOS 组之间无显著差异。NGS 显示，IVM-PCOS、IVM-非 PCOS 和对照 IVF 停滞胚胎的非整倍体率分别为 75%、75%和 66.6%。